Telemedicine intervention effects on waist circumference and body mass index in the IDEATel project.

BACKGROUND We examine the changes in waist circumference (WC) and body mass index (BMI) in older adults enrolled in a diabetes telemedicine program. The subjects were elderly Medicare beneficiaries participating in the rural (upstate New York) cohort of Informatics and Diabetes Education and Telemedicine, a randomized, controlled trial using telemedicine to improve diabetes care in which the primary outcome was glycemic control. METHODS Ninety-two percent of the subjects had BMI >25 kg/m(2), and 65.8% had a BMI > or =30 kg/m(2). Intervention subjects received home televisits with a dietitian or nurse educator every 4-6 weeks. Blood glucose and blood pressure values were reviewed, and lifestyle and medication changes were recommended. Non-intervention subjects received usual care through their primary care physicians. Change in WC, BMI, diet, and exercise behaviors and knowledge were examined at baseline and 12 and 24 months. A mixed-effects path analysis was performed to examine direct and indirect effects. RESULTS The telemedicine participants increased diet and exercise knowledge over time (P < 0.001). It was estimated that women in the telemedicine group reduced their WC over the 2 years by 1.2 cm, whereas women in the usual care group increased their WC by almost 1 cm (P = 0.02). Path analysis demonstrated that the intervention, through improved diet and exercise knowledge, was related to the decrease in WC (P = 0.006) and BMI (P = 0.004). CONCLUSIONS Diabetes case management using telemedicine improved self-reported diet and exercise knowledge, practices, and behaviors, which in turn was associated with reductions in WC and BMI at 2 years.