Healthcare utilization and cost impact of telehealth-delivered nutrition therapy for type 2 diabetes and obesity: a retrospective claims-based study
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Importance
Type 2 diabetes (T2D) and obesity drive substantial morbidity and spending. Rigorous evidence on the impacts of intensive digitally delivered lifestyle interventions on healthcare cost and utilization are critical to assessing their value.
Objective
To determine the impact of a telehealth-delivered individualized nutrition therapy (INT) program on per-member-per-month (PMPM) total cost of care (TCOC) and utilization over 12 and 24 months, overall and within T2D and obesity cohorts.
Design
Retrospective propensity score matched difference-in-differences analysis of one- and two-year cost and utilization outcomes over the study period of January 2017–March 2025.
Setting
US adults with either T2D or obesity participating in a telehealth T2D and obesity management program.
Participants
Participated in INT for ≥6 months, had ≥12 months pre-index and ≥6 months post-index claims coverage (allowing ≤30-day gaps), matched 1:1 to external controls drawn from a 2.4-million-patient pool. Final matched sample: 4,578 INT participants and 4,578 controls (per arm: 3,210 with T2D and 1,368 with obesity).
Exposures
INT: telehealth-delivered, continuous care integrating individualized carbohydrate-reduced nutrition support, clinician-guided medication management, health coaching, and remote biometric monitoring.
Main Outcomes and Measures
Outcomes included allowed inpatient, outpatient, and prescription medication costs; inpatient, emergency department (ED), primary care, cardiology, and endocrinology visits; and laboratory services. For T2D, PMPM spending and deprescription rates for each T2D-indicated medication.
Results
Among 9,156 matched adults, INT participation was associated with lower TCOC: −$215 PMPM lower total cost of care at 12 months and −$184 PMPM over 24 months (both P<.001), driven by inpatient (−$129 and −$104 PMPM) and pharmacy (−$80 and −$79 PMPM) reductions; outpatient costs did not differ significantly. In the T2D cohort, significant cost savings were driven by deprescription of SGLT2 inhibitors (62.2% reduction in medication usage PMPM), sulfonylureas (50.3%), insulin (26.5%), and GLP-1s (13.7%).
Conclusions and Relevance
In this large, real-world analysis, a nutrition-first digital care model was associated with sustained reductions in total spending and acute utilization over 12–24 months, with near-term prescription spending reductions in the cohort with T2D and broader, gradual savings in the cohort with obesity. Together with prior clinical evidence, these findings suggest alignment of clinical durability and cost reductions of a telehealth-delivered lifestyle intervention.
