Understanding How Health Policy Affects Weight Loss Counseling and Diabetes Care

This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final. COVID-19-Related Project Enhancement People with diabetes are at high risk of death from COVID-19. To reduce the risk of COVID-19, many health systems shifted from in-person care to telehealth. Telehealth provides care to patients remotely using phone, video, or other devices that can help manage care. With this enhancement, the research team will assess the use of the obesity counseling program before, during, and after COVID-19. The study's PaTH Clinical Data Research Network has access to data for over 2,200 primary care clinics across five health systems. The team will compare telephone, video, and in-person visits for patients with Medicare. They will look at weight loss and diabetes outcomes. Enhancement Award Amount: $484,638 What is the research about? Almost half of adults in the United States have diabetes or are at risk for diabetes. Diabetes can cause serious health issues, such as kidney failure, heart disease, stroke, or blindness. People who are overweight are more likely to develop type 2 diabetes than people who aren't overweight. Losing weight may help people who are overweight prevent or delay the start of type 2 diabetes. Among people who already have type 2 diabetes, losing weight can help control blood sugar levels, prevent or delay health problems, and reduce the amount of diabetes medicine they need to take. The Centers for Medicare & Medicaid Services pays for obesity screening and counseling for people who are enrolled in the Medicare and Medicaid programs. With the Affordable Care Act, private health insurance plans also began to pay for these services. This study is examining how this Affordable Care Act policy change affects the health of people with, or at risk for, diabetes. Who can this research help? States and healthcare organizations can use findings from this study to understand how policies affecting services for people who have or who are high risk for diabetes can affect their health. What is the research team doing? Researchers at six health systems in Pennsylvania, Maryland, and Utah are using electronic health records to identify adult patients with type 2 diabetes or patients who are overweight and at risk for diabetes. The team reviews electronic health records and medical insurance claims from these patients before and after the obesity counseling policy took effect to learn whether people with diabetes or people who are at high risk for diabetes receive obesity counseling whether people are more or less likely to receive obesity counseling based on age, ethnicity, where they live, or who they visit for health care whether obesity counseling services affect patients' weight loss, risk of getting diabetes, blood sugar management, and blood pressure control The research team includes five patients who meet monthly with the study team, attend trainings about conducting research, and help plan the study. Every three months, the team meets with healthcare professionals and representatives from regional and national diabetes organizations who give input into study decisions. Research methods at a glance Design Elements Description Design Observational: cohort study Population Adults ages 18 years and older who have type 2 diabetes or are at risk for diabetes, who visited a primary care doctor in the past 3 years Interventions/ Comparators Regular care Obesity counseling Outcomes Primary: weight loss Secondary: diabetes incidence, blood pressure control, use of a statin medication, and hemoglobin A1c (for patients with type 2 diabetes); percent of patients who develop diabetes (for patients at risk for diabetes). Timeframe 10-year follow-up for primary outcome