Experience with intensive preventive counseling followed by remote monitoring of behavioral risk factors for overweight in patients with noncommunicable diseases

Aim. To evaluate the effectiveness of digital technologies for intensive preventive counseling followed by remote monitoring of behavioral risk factors (BRF) for overweight in patients with noncommunicable diseases (NCDs) in a real-world practice to validate a management and functional model of interdisciplinary collaboration between a primary care physician and a preventive medicine specialist.

Material and methods. This prospective comparative cohort study was conducted among patients with a BMI ≥25 kg/m2 who underwent a clinical trial followed by remote monitoring of the PFR using the Doctor PM digital platform at healthcare facilities in three Russian regions. Of the 306 patients who completed the initial visit, 250 ended the 6-month follow-up period. A case-control study was conducted to form a study group of 72 patients with NCDs subject to outpatient follow-up and a control group of 72 patients without NCDs, stratified by age. Intensive preventive counseling was conducted with the setting of individualized goals for weight loss and BRF modification, including poor diet and low physical activity. Patients reported their weight, steps, and blood pressure (BP) data every 3 days for 6 months, and also completed a food frequency questionnaire in a mobile app once a week. Statistical analysis included intergroup (Mann-Whitney U-test, chi-square test) and intragroup (Wilcoxon signed-rank test) assessment at a significance level of p<0,05.

Results. Analysis of intergroup differences in dietary habit changes revealed significant differences in the consumption of vegetables, fruits, and grains (p=0,043). By the end of the follow-up period, it was higher in the group with NCDs. This group also showed a decrease in salt intake, while patients without NCDs more often reduced their intake of fats and simple carbohydrates. In the first month, physical activity levels were higher in patients without NCDs (p=0,019). From the second month until the end of the study period, no intergroup differences were observed (p>0,05). The decrease in body weight (BW), body mass index (BMI) and waist circumference (WC) was comparable in both groups as follows: BW -3,95 kg [-1,8; -7,6] (NCDs) and -4,0 kg [-1,0; -7,3] (without NCDs), p=0,34; BMI -1,3 kg/m² [-0,7; -2,8] and -1,5 kg/m² [-0,3; -2,8], p=0,35; WC -3,0 cm [0,0; -6,8] and -2,0 cm [0,0; -6,0], p=0,22 (intragroup p for all <0,001). The proportion of those who achieved BW reduction ≥5% was the same — 44,4% in each group (p=1,000). No intergroup differences were found in the frequency of BP data transmissions (p=0,906). Intragroup analysis showed reductions in SBP and DBP in the NCD group (p=0,025; p=0,019) and a reduction in DBP without significant change in SBP in the non-­NCD group (p=0,005; p=0,065).

Conclusion. The obtained results indicate comparable effectiveness of organizational technology for intensive preventive counseling with remote monitoring of BRFs using the Doctor PM platform in both patients with NCDs eligible for outpatient monitoring and patients without NCDs. Positive changes in monitored indicators and high patient adherence suggest integration of this technology into outpatient follow-up through an organizational and functional model of interdisciplinary collaboration between general practitioners and preventive medicine specialists. The findings also provide grounds for extending the use of this technology to patients with behavioral risk factors, in particular those with overweight and obesity not eligible for outpatient follow-up, to foster sustained motivation for dietary behavior correction and regular selfmonitoring at earlier risk stages.

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