Telematic monitorization and intensification for life style modification as a treatment for obesity and cardiometabolic risk prevention

• Autores: Valeria Alcántara Aragón
• Directores de la Tesis: Cintia González Blanco (dir. tes.)
• Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2018
• Idioma: español
• Tribunal Calificador de la Tesis: Alberto Goday Arno (presid.), Marga Giménez Álvarez (secret.), Pau Herrero Viñas (voc.)
• Programa de doctorado: Programa de Doctorado en Medicina por la Universidad Autónoma de Barcelona
• Materias:
  • Ciencias médicas
    • Medicina interna
      • Endocrinología
• Enlaces
  • Tesis en acceso abierto en:  TESEO  TDX 
• Resumen

  • Obesity, Type 2 diabetes mellitus (T2DM) and their complications are public health issues that have progressively increased in the past decades at an almost worldwide scale. Given this alarming trend and the growing population affected, most health-care systems are unable to assume the intensified treatments that would be needed for obesity and T2DM prevention. Telemedicine is a promising field given the broad and ubiquitous use of the Internet and the popularization of connection devices. The term telemedicine literally means “healing at a distance”. The telemedicine project PREDIRCAM2, consisted of the design and clinical validation of a web platform for the treatment of obesity, T2DM prevention and healthy lifestyle promotion. A multidisciplinary team composed of engineers and health professionals designed the platform. Healthy volunteers tested its functionality and then it was validated in a clinical trial. Inclusion criteria were: adults younger than 65 years old, body mass index (BMI) of 30 to 39kg/m2, not receiving any medications for blood glucose, blood pressure, lipid or weight control at the time of recruitment. 183 participants were recruited in two participant centers and were randomized in two groups: a non-telematic (NTI) intervention control group, and an experimental group that received a telematic intervention (TI). Both groups received one-year follow-up. Participants in the NTI group received full in-person care in 9 visits and participants of the TI group received 5 in-person visits plus access to the web platform were they performed 4 telematic visits and received continued telematic support for 1-year. General dropout rates were 31.1% at 6 months and 42.1% at 12 months. At 6-months follow-up the dropout rates were significantly higher for the TI group (38% TI vs. 24% NTI, X2 p = 0.034); this difference tended to diminish towards the end of the study. Both groups lost weight significantly at short term. The TI group lost more weight however this difference was not statistically significant in the intention-to-treat analysis. Metabolic results were similar between groups, finding a progressive reduction of HbA1c values during follow-up. At long term, both groups tended to regain weight beginning at 9-months follow-up, these 9 to 12-month changes were not statistically significant. In the completers analysis, the percentage of participants who achieved a ≥5 weight loss was significantly greater for the TI group (65% TI vs. 43% NTI, MWU p = 0.031). BMI, waist circumference and percentage of weight-loss showed similar results at 9 months follow-up. However these differences were not significant in the intention-to-treat analysis. Satisfaction evaluations showed an adequate acceptance of the telematic intervention and functionality of the PREDIRCAM2 platform. The need to incorporate behavior change psychologists into the multidisciplinary team for future interventions is suggested by the most frequently reported reasons for dropout, as well as by expressed participant opinions. The incorporation of automatized systems may be useful to improve dietary logging, potentially improving usability and adherence. The cost-effectiveness evaluation showed the TI intervention was -113 €/patient/year less expensive than traditional non-telematic care, mainly by reducing cost in health-care appointments. The use of physical activity tracking devices with pulsometers made the TI more expensive than the NTI (+24 € (p=0.001, CI 95% 7.5 – 24.35). Every day technologies, such as mobile devices, pedometers, and social media should be incorporated into future studies of telemedicine interventions on obesity and T2DM prevention and may improve their cost-effectiveness. Telemedicine treatment delivered by the PREDIRCAM2 web platform is effective for the treatment of obesity, T2DM prevention at a reduced cost when compared to traditional full in-person intensified care.