Impact of telehealth nutrition therapy on costs and utilization in type 2 diabetes & obesity
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Importance
Type 2 diabetes 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
Determine the impact of a telehealth-delivered individualized nutrition therapy program on per-member-per-month (PMPM) total cost of care 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 participating in a telehealth T2D and obesity management program.
Participants
Participated in program 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 participants and 4,578 controls (per arm: 3,210 with type 2 diabetes and 1,368 with obesity).
Exposures
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 PMPM allowed inpatient, outpatient, and prescription medication costs; inpatient, emergency department, primary care, cardiology, and endocrinology visits; and laboratory services. For type 2 diabetes, PMPM spending and monthly usage rates for each indicated medication.
Results
Among 9,156 matched adults, program participation was associated with a $215 PMPM reduction in the total cost of care at 12 months (−$184 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.
Key points
Question
Is participation in a telehealth-delivered individualized nutrition therapy program associated with changes in total healthcare costs and utilization among adults with type 2 diabetes or obesity?
Findings
In this retrospective cohort study of 9,156 matched adults, participation in the program was associated with significantly lower total cost of care at 12 months (−$215 per member per month) and 24 months (−$184 per member per month), primarily due to reductions in inpatient and pharmacy spending.
Meaning
A telehealth-delivered nutrition therapy program may significantly reduce healthcare spending for adults with type 2 diabetes or obesity.
