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).