1Department of Medicine, Division of Endocrinology and Metabolism, USA
2Martinsville Henry County Coalition for Health and Wellness, USA
3Tri-Area Community Health Centers, USA
*Corresponding author:Richard J Santen MD, Division of Endocrinology and Metabolism, University of Virginia Health System, Charlottesville, USA
Submission: March 09, 2023Published: March 21, 2023
Background: Rural, medically-underserved, financially-challenged geographical areas lack
endocrinologists to provide consultation and management of patients with uncontrolled diabetes.
Our prior studies in 139 patients with diabetes attending rural, Federally Qualified Community Health
Centers, demonstrated the utility of telemedicine to link patients with endocrinologists and markedly
improve glycemic control. However, a critical limitation was the inability to achieve weight reductions,
even with nutritional education.
Study Design: This pilot study utilized meal replacements linked to an integrated, technology-driven
strategy for management of patients with uncontrolled diabetes in underserved areas. Primary and
secondary goals: Our primary goal was weight reduction and secondarily, improved glucose control.
Result: Eleven patients completed 3 months of the program and 7, the entire 6 months. In the 11 patients
evaluated at three months, body weights dropped from 271±16 to 252±11 (SEM) pounds (P=0.002). The
meal replacement diet was associated with a decrease in insulin requirements with doses falling from
221±41 to 129±23 (SEM) units daily (P=0.004). Hemoglobin A1c levels declined from 9.85±0.33% to
7.93±0.31% (SEM) (p=0.001). In the 7 patients completing the entire 6 months of the protocol, similar
reductions persisted. Mean compliance with meal replacements on a scale of 0 to 10 ranged downward
from 8.6 to 7.6 (P=NS) with increasing duration of study.
Conclusion: The study was unique in tailoring a program specifically to rural, underserved areas and
demonstrated weight, insulin dose, and HbA1c reductions. The data now require confirmation of the use
of meal replacements linked to multiple technologies in a future, randomized trial.
Keywords:Nutrisystem®D® meal replacement; Glucommander-outpatient; Telcare meter; telemedicine; Remote consultation; Federally qualified community health centers
Abbreviations: CDCES: Certified Diabetes Care and Education Specialists