Healthcare Cost Impacts of Telehealth-Delivered Nutrition Therapy among US Adults with Type 2 Diabetes or Obesity: A Matched Difference-in-Differences Analysis.

INTRODUCTION: Type 2 diabetes (T2D) and obesity are associated with substantial morbidity and healthcare spending. Although telehealth-delivered lifestyle interventions have demonstrated clinical benefits, evidence on their impact on healthcare costs and utilization remains limited. This study evaluated the association between participation in a comprehensive nutrition-first digital care model integrating individualized carbohydrate-reduced nutrition support, clinician-guided medication management, health coaching, and remote biometric monitoring on total healthcare costs and utilization over 1 year and 2 years. METHODS: We conducted a claims-based, retrospective propensity score matched difference-in-differences analysis of cost and utilization outcomes among US adults with T2D or obesity who (1) enrolled in Virta Health's Individualized Nutrition Therapy (INT) program or (2) had a primary care visit for either condition between 2017 and 2025. Per-member, per-month (PMPM) outcomes included inpatient, outpatient, and prescription medication costs, as well as inpatient, emergency department, primary care, cardiology, and endocrinology visits. For the T2D cohort only, PMPM costs for each diabetes medication were also evaluated. RESULTS: Among 3819 adults with T2D and 2761 adults with obesity, program participation was associated with $240 and $256 PMPM reductions in total cost of care at 12 months, respectively (-$230 and -$189 PMPM over 24 months; all p < 0.001). Among adults with T2D, savings were driven by reduced inpatient visits and deprescription of sodium-glucose cotransporter 2 (SGLT2) inhibitors (66.8% reduction from baseline cost), sulfonylureas (51.7%), insulin (43.9%), and glucagon-like peptide-1s (GLP-1s) (32.2%). Among adults without T2D and with obesity, reductions accrued across all cost categories. CONCLUSIONS: In this large, real-world analysis, enrollment in a comprehensive nutrition-first digital care model was associated with reductions in healthcare costs and utilization over 12 and 24 months, with prescription medication cost reductions emerging within the first quarter of treatment among adults with T2D. Together with prior evidence demonstrating clinical effectiveness, these findings suggest that comprehensive digital nutritional care models can generate meaningful economic value.