Assessing the Effects of Intensive Behavioral Therapy on Weight Loss among Patients with or at Risk for Type 2 Diabetes

Results Summary

What was the research about? Losing weight may prevent or delay the start of type 2 diabetes and prevent health problems due to diabetes. Obesity counseling called intensive behavioral therapy, or IBT, is effective for weight loss. In IBT, doctors screen and counsel patients about weight management. After 2012, health insurers started to reimburse primary care doctors for IBT. In this study, the research team used health records and insurance claims from 2009 to 2020 for patients with diabetes or at risk for diabetes at six health systems to see how: The payment change for doctors affected use of IBT. IBT affected patients' weight loss and other health outcomes. What were the results? Before the payment change, health records rarely captured IBT use. After the payment change, less than 1 percent of eligible patients received IBT. Among patients receiving IBT, the usual number of IBT visits was one. Among patients with diabetes, weight loss and blood pressure control didn't differ between patients who did and didn't receive IBT. Patients who received IBT had a larger decrease in blood sugar levels. They also had a smaller increase in uncontrolled diabetes. Among patients at risk for diabetes, patients gained weight whether they received IBT or not. Patients who received IBT gained more weight than patients who didn't receive it. Changes in blood sugar levels and blood pressure didn't differ between patients who did and didn't receive IBT. What did the research team do? The research team looked at how many patients received IBT before and after the payment change. The team looked at data for 567,908 patients with diabetes and 2,054,256 patients at risk for diabetes. Across these patients, 80 percent were White, 11 percent were Black or African American, 8 percent were another race or race was missing; 5 percent were Hispanic. The average age was 47, and 57 percent were women. To assess the effects of IBT, the research team compared patients who received IBT with patients who didn't receive it but were eligible based on their weight. The team looked at changes in health outcomes from one year before patients had, or were eligible for, IBT versus one year later for: 4,944 patients with diabetes. Of these, 75 percent were White, 20 percent were Black or African American, and 1 percent were another race; 3 percent were Hispanic. The average age was 58, and 62 percent were women. 10,781 patients at risk for diabetes. Of these, 83 percent were White, 12 percent were Black or African American, and 1 percent were another race; 3 percent were Hispanic. The average age was 44, and 80 percent were women. Patients with diabetes, doctors, and staff from health systems, diabetes organizations, and community organizations gave input on the study. What were the limits of the study? Data didn't include things like doctor practices, which could have affected the results. Future research could look at reasons for the low use of IBT. How can people use the results? Patients and their doctors can use the results when considering IBT for diabetes. How this project fits under PCORI's Research Priorities The research reported in this results summary was conducted using PCORnet®, the National Patient-Centered Clinical Research Network. PCORnet® is intended to improve the nation's capacity to conduct health research, particularly comparative effectiveness research (CER), efficiently by creating a large, highly representative network for conducting clinical outcomes research. PCORnet® has been developed with funding from the Patient-Centered Outcomes Research Institute® (PCORI®).