Isabel Fegers-Wustrow, Sarah Rust, Marlo Verket, Kerstin Schäfer, Anna Feuerstein, Alessandra Boscheri, Sophia M T Dinges, Ephraim B Winzer, Martin Halle, Axel Linke, Pia von Korn, Frank Edelmann, Stephan Mueller, Janosch Krotz, Marcus Dörr, Rolf Wachter, Bernd Wolfarth, Oliver Wolfram, Volker Amelung, Clara Dubois, Björn Hackenberg, Thomas Nebling, Felix Freigang, Julian Treitschke, Felix Gass
Journal: Nature medicine 2025;31(4):1203-1213
PMID: 39920395
Coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) are long-term conditions that may occur together. When a person has both conditions, their risk of heart attacks, stroke, and other serious complications may be higher. Good blood sugar control is essential to reduce these risks. However, maintaining healthy lifestyle habits such as regular exercise and balanced eating can be challenging, especially for people managing multiple conditions. Telemedicine, which enables remote delivery of healthcare services, may help improve access to structured lifestyle support.
This multicentre randomised controlled trial aimed to evaluate whether a telemedicine-supported lifestyle intervention could improve blood sugar control in patients with both CHD and T2DM. A total of 502 patients were randomly assigned to either an intervention group or a usual care group. The intervention included home-based exercise training, nutritional counselling, and health literacy education, supported by regular remote feedback from healthcare professionals. The main outcome measured was glycated haemoglobin (HbA1c), which reflects average blood sugar levels over the previous 2–3 months. After six months, the intervention group showed a statistically significant reduction in HbA1c compared to the usual care group. This indicates improved long-term blood sugar control. The structured telemedicine approach helped patients adopt and maintain healthier behaviours, contributing to better blood sugar management. Weight loss and restraint from eating were associated with significant improvements following intervention. Waist circumference, blood lipids, and blood pressure were not significantly affected by the intervention.
In conclusion, this study demonstrates that telemedicine-supported lifestyle interventions can effectively improve blood sugar control in high-risk patients with CHD and T2DM. Healthcare professionals may consider incorporating remote lifestyle programmes into routine care, particularly for patients who face barriers to attending in-person programmes. Such approaches could enhance long-term disease management and reduce cardiovascular risk.
Patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) have a substantially increased risk for major cardiovascular events and mortality. Increasing physical activity and improving a healthy diet may effectively reduce cardiovascular risk factors; however, the effects are often transient. In a multicenter, 1:1 randomized controlled trial including 502 patients with combined CHD and T2DM (68 ± 8 years; 84% men), we assessed the effects of a home-based telemedicine-supported lifestyle intervention (exercise training, nutritional recommendations and health literacy training) with regular individualized feedback versus usual care. The study met its primary endpoint of reduced glycated hemoglobin after 6 months in favor of the lifestyle intervention group (mean between-group difference in the complete-case analysis (n = 197 and n = 193), -0.13% (95% confidence interval, -0.25 to -0.01), P = 0.04). When individualized feedback and health literacy training were discontinued after 6 months (while other telemedicine tools were maintained), no statistically significant between-group differences were observed at 12 months. At 12 months, 31 patients (6.2%) had a major adverse cardiovascular event (lifestyle intervention, n = 20 (8.0%); usual care, n = 11 (4.4%); P = 0.15), with the main reason being hospitalization for angina or revascularization (lifestyle intervention, n = 15; usual care, n = 8). There were five deaths (lifestyle intervention, n = 2; usual care, n = 3), none of which were categorized as related to the intervention. However, three events that resulted in hospitalization were categorized as potentially related to the intervention (decompensation of heart failure, vertebral disc prolapse and inguinal hernia). In conclusion, a home-based lifestyle intervention with telemedicine support showed modest effects in patients with CHD and T2DM. ClinicalTrials.gov registration: NCT03835923 .
© 2025. The Author(s).
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