Impact of telehealth nutrition therapy on costs and utilization in type 2 diabetes & obesity

Importance

Type 2 diabetes and obesity drive substantial morbidity and spending. Rigorous evidence on the impacts of 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 (INT) program on per-member-per-month (PMPM) total cost of care and utilization over one and two years.

Design

Retrospective propensity score matched difference-in-differences analysis of cost and utilization outcomes over the study period of January 2016–March 2025.

Setting

US adults participating in a telehealth T2D and obesity management program.

Participants

Enrolled in INT for >1 day or had PCP visit for T2D or obesity during study period; had ≥12 months pre-index and ≥90 days post-index claims coverage (allowing ≤30-day gaps). Final matched sample: 6,580 participants and 6,580 controls (per arm: 3,819 with type 2 diabetes and 2,761 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. For the T2D cohort, PMPM spending and proportion of days covered for each T2D medication.

Results

Among 3,819 adults with T2D and 2,761 adults with obesity, program participation was associated with $240 and $256 PMPM reductions in the total cost of care at 12 months (−$230 and $189 over 24 months, all P<.001). In the T2D cohort, savings were driven by deprescription of SGLT2 inhibitors (66.8% reduction in PMPM cost), sulfonylureas (51.7%), insulin (43.9%), and GLP-1s (32.2%). In the obesity cohort, reductions accrued across inpatient, outpatient and prescription medication settings.

Conclusions and Relevance

In this large, real-world analysis, a nutrition-first digital care model was associated with sustained reductions in cost and utilization over 12–24 months, with immediate prescription medication cost reductions in the cohort with T2D and broader savings in the cohort with obesity. Together with prior clinical evidence, these findings suggest alignment of clinical effectiveness and cost reductions of a telehealth-delivered lifestyle intervention.

Key points