Implementing 1:1 Lifestyle Medicine Coaching Visits for Management of Uncontrolled Type 2 Diabetes: Cone Health...

Lifestyle medicine (LM) provides a high-value framework for treating and potentially reversing chronic diseases, such as type 2 diabetes (T2D), obesity, cardiovascular diseases, and some cancers. Yet, the field of LM is still growing, and few examples exist of how to successfully implement LM into clinical care. This paper describes the implementation of 1:1 lifestyle medicine (LM) coaching visits for 45 patients with uncontrolled type 2 diabetes (T2D), (mean HbA1c 10.5%) and on multiple diabetes medications, at Cone Health's Reidsville Endocrinology practice in North Carolina, USA. In brief, during routine endocrinology visits, the lead physician of the LM program at Cone Health, who is trained in LM, identified patients with uncontrolled T2D where scheduling allowed him to fit in some additional time for coaching. Forty-five interested patients selected over a period of several weeks from Spring of 2022 to Fall of 2022 made the first cohort. During a typical LM encounter, immediately after addressing their referral concerns with a routine endocrinology consult, verbally consenting patients were personally invited to learn more about LM. They were provided with a packet of materials focused predominately on prescribing nutrition and exercise as treatment for chronic disease. The physician spent an additional 10-15 minutes with each verbally consenting patient to go through selected materials in the packet, focusing largely on nutrition and physical activity, and successfully billed for the additional time. The patients were encouraged to take the packet home for further learning and return to their next routine visits with questions and to engage in further coaching. Following this brief but intensely focused coaching session which was done in addition to the routine endocrinology visit, lifestyle medicine coaching was able to be incorporated into subsequent, routine endocrinology visits in many of the initially identified patients. The majority of these patients also accepted a referral to a dietitian in the same practice. This experience highlights a model for potentially integrating LM coaching into routine practice and, consistent with previous research, highlights the importance of a site champion for successful LM implementation. Future research is needed to formally assess the success of coaching visits, particularly in terms of assessing health outcomes in patients who engaged in the 1:1 coaching.