Patients with Diabetes Benefit from Tele-Behavioral Treatment

Marie Thibault

Companies delivering healthcare in new ways are receiving plenty of attention for their potential to save time and money. Many of these companies are trying to prove the benefits of their novel delivery methods and the effectiveness of the healthcare delivered. 

AbilTo, a company that offers HIPAA-compliant tele-behavioral treatment for several patient categories, is part of this new wave of healthcare. As explained on the company’s website, patients can receive eight-week treatments over secure video or phone. The company’s targeted programs are offered for patients with diabetes, chronic pain, gastrointestinal illness, respiratory conditions, cardiac incidents, cancer, as well as postpartum patients and people dealing with the death of a loved one or serving as a longterm caregiver. 

AbilTo intends to reach patients who have hit a particularly tough time, what the company calls a “Health Inflection Point.” This is because “Particularly at a Health Inflection Point, patients can experience anxiety, stress and depression that can interfere with their medical recovery,” according to the company website.

Today, AbilTo unveiled the results of a retrospective study focused on patients with diabetes, showing that tele-behavioral treatment led to improvements in depression, anxiety, stress, self-management, and glucose levels in patients with diabetes. The study findings were published today in a Telemedicine and e-Health article, “A Tele-Behavioral Health Intervention to Reduce Depression, Anxiety, and Stress and Improve Diabetes Self-Management.”

The study included 466 consecutive patients with diabetes who graduated from the AbioTo eight-week program and enrolled between August 1, 2014 and January 31, 2015. Patients received a consultation and then eight sessions with the behavioral health provider and seven with a behavioral coach. Patient were required to have both diabetes mellitus and to have experience a recent medical change, such as a hospitalization or new treatment regimen. 

The study’s primary outcomes was a change in depression, stress, and anxiety, as measured on the Depression Anxiety Stress Scale 21 (DASS-21). Patients were measured for baseline and graduation scores with this scale at the first consultation and upon graduation from the treatment. The researchers also studied secondary outcomes—patient changes in conducting morning glucose self-testing and the change in morning blood glucose level as reported by the patient.  

Of the patients in the study, 58% said they had experienced past depression or anxiety and half of the participants had an elevated depression, anxiety, and/or stress score at the time of their first consultation. Almost all (92%) of patients had baseline morning glucose levels of 100 mg/dL or higher. 

The article authors, all AbilTo employees, wrote, “Nearly one in ten people in the United States have diabetes, suggesting that widely disseminated programs effective to reduce psychological distress in diabetes patients could have significant public health impact. Moreover, studies suggest that diabetes paired with a comorbid mental health condition is associated with significantly increased cost of care.”

In the study, patients who had high initial DASS scores had significant reductions in mean depression, anxiety, and stress upon graduation—a 51% reduction in mean depression scores (-8.8 points, p<0.0001); a 45% reduction in anxiety scores (-6.9 points, p<0.0001); and a 45% reduction in stress scores (-9.9 points, p<0.0001). Of the patients with initial elevated depression scores, 67% had reached normal scores at the end of treatment, while 59% of patients with high anxiety scores and 70% of this with high stress scores had achieved normal scores at graduation. Most patients with non-normal initial DASS scores improved (81% of those with high depression scores, 80% of those with high anxiety scores, 86% of those with high stress scores). Less than 7% of patients moved to higher (more severe) scores in one or more of the DASS categories.

Self-management also improved in these patients. Of the study participants, 60% initially self-tested and noted their morning glucose levels at least once per week; at graduation this had increased to 69% of patients. Mean morning glucose had also improved, from 146.2 +/- 50.9 mg/dL initially to 135.8 +/- 43.1 mg/dL at the end.

There was association between DASS scores and morning glucose levels, too. The authors wrote, "Participants with normal depression scores at graduation were more likely to have lower morning glucose levels (< the mean) at graduation versus those with non-normal graduation depression scores (odds ratio [OR] =  2.0; 95% CI =  1.1– 3.7); similar associations were observed between normal graduation anxiety (OR =  1.2; 95% CI =  0.7–2.1) and stress (OR =  2.1; 95% CI =  1.1–3.9) scores and odds of having lower glucose levels at graduation.”

The authors concluded, “The results provide new evidence that a behavioral health intervention specifically designed for tele-delivery can be associated with improved diabetes self-management."

“Programs such as AbilTo’s are effective in motivating diabetes patients to make healthy changes at a gradual pace. By fostering skills like improving and tracking food choices, participants learn the clear connection between their behaviors and stable blood glucose levels. They leave the program with a new sense of confidence and control, as well as a practical plan for sustaining their health improvements,” said AbilTo chief clinical officer and study co-author Aimee Peters, LCSW, in a press release. 

The article authors wrote that future research might involve “reassessment of participant outcomes over the longer term to determine persistence of improvements gained over the course of the program period.”

Last February, AbilTo, in collaboration with Aetna, showed that tele-behavioral intervention for patients with a recent cardiac event improved patient outcomes, cut hospital admissions, and reduced healthcare costs. The results were published in The American Journal of Managed Care. 

Last fall, Reena Pande, MD, MSc, one of the article co-authors and the company’s chief medical officer, spoke at the FT Digital Health Summit USA in New York City about the importance of evidence for digital health companies like AbilTo. She said, “I think the burden is on us to prove that utilization drives good quality and a good ROI. And then fee-for-service works, because we’re being held to proof that by using more good quality care, you can actually save money on the back end. So I think the burden is on folks like us to actually prove that utilization drives good outcomes, and good outcomes drive cost savings in the healthcare system.”

Marie Thibault is the associate editor at MD+DI. Reach her at [email protected] and on Twitter @medtechmarie. 

[Images courtesy of ABILTO and GOLDY/FREEDIGITALPHOTOS.NET and ]