RESEARCH ARTICLE


TECNOB Study: Ad Interim Results of a Randomized Controlled Trial of a Multidisciplinary Telecare Intervention for Obese Patients with Type-2 Diabetes



Gianluca Castelnuovo1, 3, *, Gian Mauro Manzoni1, 2, Paola Cuzziol1, 2, Gian Luca Cesa1, Stefania Corti1, Cristina Tuzzi4, Valentina Villa1, Antonio Liuzzi 5, Maria Letizia Petroni 4, Enrico Molinari 1, 3
1 Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Ospedale San Giuseppe, Verbania, Italy
2 Department of Psychology, University of Bergamo, Italy
3 Department of Psychology, Catholic University of Milan, Italy
4 Istituto Auxologico Italiano IRCCS, Laboratory of Nutrition Research, Ospedale San Giuseppe, Verbania, Italy
5 Istituto Auxologico Italiano IRCCS, Diabetes Research Laboratory, Ospedale San Giuseppe, Verbania, Italy


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© Castelnuovo et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Psychology Research Laboratory, San Giuseppe Hospital, Istituto Auxologico Italiano, Via Cadorna, 90, 28824 Piancavallo (VB), Italy; Tel: 0039 323 514338; Fax: 0039 323 514338; E-mail: gianluca.castelnuovo@auxologico.it


Abstract

Background:

Obesity increases the risk of many health complications such as hypertension, coronary heart disease and type 2 diabetes, needs long-lasting treatment for effective results and involves high public and private care-costs. Therefore, it is imperative that enduring and low-cost clinical programs for obesity and related co-morbidities are developed and evaluated. Information and communication technologies (ICT) can help clinicians to deliver treatment in a cost-effective and time-saving manner to a large number of obese individuals with co-morbidities.

Objective:

To examine ad interim effectiveness of a 12-month multidisciplinary telecare intervention for weight loss provided to obese patients with type 2 diabetes.

Design, Setting, and Participants:

A single-center randomized controlled trial (TECNOB study) started in December 2008. At present, 72 obese patients with type 2 diabetes have been recruited and randomly allocated to the TECNOB program (n=37) or to a control condition (n=39). However, only 34 participants have completed at least the 3-month follow-up and have been included in this ad interim analysis. 21 out of them have reached also the 6-month follow-up and 13 have achieved the end of the program. Study is still on-going.

Intervention:

All participants attended 1-month inpatient intensive program that involved individualized medical care, diet therapy, physical training and brief psychological counseling. At discharge, participants allocated to the TECNOB program were instructed to use a weight-loss web-site, a web-based videoconference tool, a dietary software installed into their cellular phones and an electronic armband measuring daily steps and energy expenditure.

Main Outcome Measures:

Weight and disordered eating-related behaviors and cognitions (EDI-2) at entry to hospital, at discharge from hospital, at 3,6 and 12 months.

Results:

Ad interim analysis of data from 34 participants showed no statistically significant difference between groups in weight change at any time-point. However, within-group analysis revealed significant reductions of initial weight at discharge from hospital, at 3 months, at 6 months but not at 12 months. Control group had higher scores in Interpersonal distrust at 12 months.

Conclusion:

This ad interim findings revealed that the effect of the inpatient treatment was high and probably overwhelmed the effect of the TECNOB intervention. Much statistical power and long-term follow-up may enhance the probability to detect the TECNOB effect over and above the great one exerted by the inpatient program.

Keywords: Obesity, type-2 diabetes, weight loss, weight loss maintenance, telemedicine, telecare, RCT.