INTRODUCTION
Treatment and prevention of
cardiometabolic chronic diseases such as high adiposity, hypertension,
and dysglycemia require a complex approach as well as identification of
determinants of health affecting patient care and outcomes, this is a
vital step in the translation of real-world evidence and best practice
into the routine clinical setting [1].
Healthcare delivered by a team following a systematically designed set
of multidisciplinary protocols can increase the effectiveness of
interventions to mitigate cardiometabolic risk. This multidisciplinary
team approach (MDT) has demonstrated effectiveness in controlling weight
and associated complications within the controlled conditions of
clinical trials, but their implementation in routine clinical settings
has been limited, with little sustainability and lower efficacy. Other
adaptations of lifestyle intervention for diabetes prevention based on
the US Diabetes Prevention Program (DPP) and the Finnish Diabetes
Prevention Study (DPS) have been implemented, though results suggest
these have been significantly less effective
[2].
To promote early intervention in
patients and enhance sensitivity for detecting subjects affected by
excess adiposity, the American Association of Clinical Endocrinology
(AACE) proposed that we consider obesity as not only individuals with
body mass index (BMI) ≥ 30, but also those with BMI ≥ 25 and
weight-related complications. Furthermore, AACE suggested adopting
adiposity-based chronic disease (ABCD) as the new diagnosis term for
obesity and dysglycemia-based chronic disease (DBCD) for diabetes
[3, 4].
Unlike the model based on BMI, in addition to total fat mass, this
complication-centric approach considers the impairment of fat
distribution and function as well as other equally crucial factors
associated with the obesity-related metabolic derangements
(ethnocultural factors, social determinants of health among others).
Earlier detection of insulin resistance and/or adequate ß-cell
compensation may allow for mechanistic interventions to more efficiently
reduce the progression of dysglycemia and cardiometabolic complications
[4].
Lifedoc Health (LDH) is a multi-disciplinary and data-driven healthcare
organization committed to preventing diabetes and obesity by increasing
accessibility to care through an integrated and standardized
outcome-oriented model. Its programs have received state and National
Committee for Quality Assurance recognition and accreditation. LDH’s
clinical model combines primary and specialty care, acute and chronic
care, as well as care coordination, pharmacy, patient education, and
lifestyle counseling into a unified dynamic approach. Providers undergo
protocol training and reinforcement, PCPs are coached for the early
enrollment of patients with or at risk of cardiometabolic conditions for
MDT co-management including obesity, hypertension, elevated A1c, markers
of insulin resistance, pre-diabetes, and diabetes.
Several obstacles may limit the effectiveness of MDT co-management in
these patients including a) patient and provider perception or stigma of
obesity [5,
6], b) time constraints of providers and
limited training to manage obesity and related complications, c)
competing priorities for referral of those with multiple chronic
conditions, d) the presence of numerous social determinants of health
including limited access to preventive care, as well as job,
transportation and housing insecurity, and e) patient inertia and/or
limited health literacy towards their/their family’s health. In order to
demonstrate the effectiveness of implementing the Lifedoc model and its
accompanying protocols, we aim to evaluate and better understand the
evolution of obesity and related comorbidities according to differences
in type of care (i.e. PCP vs. PCP with MDT co-management including
wellness coach and endocrine team).