Webinar: The future of Diabetic Neuropathy Management - May, 28th
Article

Small Fiber Neuropathy – The Under-Diagnosed Peripheral Neuropathy

4 min read

In an interview with Harvard Medical School’s Harvard Health, Dr. Khosro Farhad, a neuropathy expert at Harvard-affiliated Massachusetts General Hospital, noted that small-fiber neuropathy is generally underdiagnosed because routine neurological exams and tests cannot accurately discriminate between large-fiber and small-fiber neuropathy. 

 

In a literature review of diabetic peripheral neuropathy diagnostic and screening technologies in the Journal of Diabetes Science and Technology, Kelley Newlin Lew et al pointed out that the body of research backs up the assertion that distal symmetrical peripheral neuropathy  – including both small- and large-fiber neuropathy – is underdiagnosed in primary care (1).

 

The article points out: 

Small- and large-nerve fiber DSPN (distal symmetrical peripheral neuropathy) may present exclusively or together while each subtype may increase risk for foot ulceration due to reduced sensory function, and thereby heightened risk for lower extremity amputations. According to the ADA, the clinical history and physical examination often are sufficient for diagnosis of DSPN. Yet, up to 50% of individuals with DSPN may be asymptomatic.

 

Small-fiber DSPN typically precedes large-fiber neuropathy. Small-fiber DSPN impairs functional integrity of the small thinly myelinated Aδ and unmyelinated C fibers. These small, peripheral nerve fibers prominently convey pain to the central nervous system. In DSPN, they may stimulate profound pain. Small-fiber DSPN may also adversely affect local autonomic (eg, decreased sweating, dry skin, impaired vasomotion) and thermoreceptor (cold, warm sensations) functions.

 

Often, pain and other symptoms and signs first manifest in the feet and progress proximally to the lower extremities and, in some cases, to the hands with a stocking and glove pattern. However, some with small-fiber DSPN may not experience pain. A proportion of patients with small-fiber neuropathy may present with little evidence of the disease, which may delay DSPN diagnosis.

 

 

The primary care practitioner’s toolbox for diagnosing diabetic peripheral neuropathy has been very limited to date, with tools such as temperature and pin-prick sensation, 128-Hz tuning fork, and 10-g monofilament that are neither quantifiable nor reproducible and are prone to human error. Further, since the ADA Standards of Care only call for annual foot exams for people with a diagnosis of diabetes, a large number of patients with pre-diabetes accompanied by the onset of small fiber neuropathy, miss the chance for an early diagnosis (2,3).

 

Withings is focused intently on this deficit in detection technologies in primary care and other frontline environments. As Newlin Lew points out in the Journal of Diabetes Science and Technology article, the Sudoscan® Electrochemical Skin Conductance (ESC) technology being used in our Body Pro 2 device, and that has been used in clinical settings for nearly a decade, could play an important role in improving detection and monitoring:   

 

When considered with respect to past and more recent research, Sudoscan has substantial evidence revealing it may potentially identify early DSPN (although this is not its main use) and monitor DSPN progression over time. Sudoscan also has adequate reproducibility and repeatability. Sudoscan is approved by the FDA and may be reimbursed through proper billing. Sudoscan is thus a POCD [point of care device] worthy of clinical adoption to detect and monitor DSPN in clinical settings.

 

  1. Newlin Lew K, Arnold T, Cantelmo C, Jacque F, Posada-Quintero H, Luthra P, Chon KH. Diabetes Distal Peripheral Neuropathy: Subtypes and Diagnostic and Screening Technologies. Journal of Diabetes Science and Technology. 2022 Mar;16(2):295-320. doi: 10.1177/19322968211035375. Epub 2022 Jan 7. PMID: 34994241; PMCID: PMC8861801. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8861801/
  2. Williams SM, Eleftheriadou A, Alam U, Cuthbertson DJ, Wilding JPH. Cardiac Autonomic Neuropathy in Obesity, the Metabolic Syndrome and Prediabetes: A Narrative Review. Diabetes Ther. 2019 Dec;10(6):1995-2021. doi: 10.1007/s13300-019-00693-0. Epub 2019 Sep 24. Erratum in: Diabetes Ther. 2019 Oct 4;: PMID: 31552598; PMCID: PMC6848658. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6848658/
  3.  Burgess J, Frank B, Marshall A, Khalil RS, Ponirakis G, Petropoulos IN, Cuthbertson DJ, Malik RA, Alam U. Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres. Diagnostics (Basel). 2021 Jan 24;11(2):165. doi: 10.3390/diagnostics11020165. PMID: 33498918; PMCID: PMC7911433. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911433/

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Exploring the Surge in Remote GLP-1 Prescription Access

New medications like GLP-1 agonists offer a promising tool to help patients achieve a healthy weight. But supporting patients in long-term weight loss with GLP-1 remote patient monitoring involves more than medication. “Obesity is a complex, chronic medical condition that requires comprehensive care. GLP-1 medications are powerful tools in the obesity medicine toolkit, but they must be paired with lifestyle counseling and medical oversight for success & safety,” said Lauren Lemieux, MD, FACP, Dipl. ABOM at FORM, a virtual obesity medicine clinic that empowers patients with obesity to take control of their health through a personalized weight loss plan.

 

Uncertainties persist regarding the long-term effectiveness of these medications and the best approach to determine which patients can safely discontinue the medication while maintaining weight loss, and which patients would benefit from a prolonged therapy regimen. As we continue to learn more about GLP-1 agonists, daily measurement of biometrics such as weight, BMI, blood pressure, heart rate, sleep patterns, and body composition is particularly critical to making informed care decisions. 

 

The rise in remote prescribing of GLP-1 medications reflects a broader trend toward telemedicine and GLP-1 remote patient monitoring, which is driven by technological advancements and the need for increased care access. Healthcare teams continue to face challenges in treating and managing patients remotely, including:

 

  • Limited to no regular physical patient assessment 
  • Low patient engagement and communication in their treatment plan 
  • Technical issues with devices and unreliable data measurements 
  • Inability to correlate long-term data patterns with intervention strategies

Bridge the virtual care gap. Adopt smarter healthtech.

Care teams don’t always need more technology. They need smarter technology that improves their ability to provide better patient care. Withings offers a range of digital health solutions, from connected health devices like cellular scales and blood pressure monitors to an all-in-one self service remote patient monitoring platform. These solutions directly address many of the technological barriers of virtual care.

In a March 2024 survey, Withings asked their database of device users about their experience with GLP-1 treatments. Nearly a quarter of respondents reported taking GLP-1s, with a significant majority (93%) being prescribed healthy habits alongside their treatment. 60% of users noted biomarker changes associated with their GLP-1 regimen and 76% reported Withings products had a positive influence on their treatment journey. 

 

Withings newest cellular scale, Body Pro 2, combines habit-forming user features with a pioneering modular approach to manage chronic conditions like obesity. Its core capabilities allow care teams to capture advanced health metrics such as weight and body composition, while additional features can track advanced and clinically validated biomarkers typically only available in a professional setting. 

 

Withings Health Solutions simplifies access to long-term patient data, resulting in improved support GLP-1 remote patient monitoring and faster decision-making for treatments and care strategies.

Part 2: Learn why measuring body composition is key for patients on GLP-1s

Keep Reading [post_title] => Part 1: Supporting Safe and Sustainable Weight Loss With GLP-1s - Finding the right remote health technologies [post_excerpt] => New medications like GLP-1 agonists offer a promising tool to help patients achieve a healthy weight. But supporting patients in long-term weight loss involves more than medication. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => supporting-safe-and-sustainable-weight-loss-with-glp-1s-part-1-finding-the-right-remote-health-technologies [to_ping] => [pinged] => [post_modified] => 2024-07-11 09:25:38 [post_modified_gmt] => 2024-07-11 09:25:38 [post_content_filtered] => [post_parent] => 0 [guid] => https://withingshealthsolutions.com/?p=1149 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 1150 [post_author] => 1 [post_date] => 2024-04-01 06:20:45 [post_date_gmt] => 2024-04-01 06:20:45 [post_content] =>

A key biomarker in remote GLP-1 medication management

GLP-1 agonists are remarkably effective in helping patients lose weight. But this can’t be done in a vacuum. “Ensuring safety and appropriate rate of weight loss is always a concern among healthcare providers who are remotely monitoring patients on GLP1 medication. Without having patients come into a physical clinic, there hasn’t been a means of checking health metrics, such as weight and blood pressure, in a way that they can be easily transferred into their electronic medical record for trending over time” said Kristin Baier, MD VP, Clinical Development at Calibrate, the leading clinician-guided and value-based obesity treatment program. Highlighting the importance of GLP-1 remote patient monitoring regarding weight management. 

 

One data point that’s often overlooked in a patient’s journey on GLP-1s is body composition — the proportion of lean mass and fat mass within the body, which can be subdivided into muscle mass, fat mass, water percentage, and bone mass. We now know this data is more telling than Body Mass Index (BMI). In fact, research has shown that BMI is a poor indicator of overall health and does not take into consideration the difference between muscle and fat mass. BMI oversimplifies health assessments, neglecting insight into crucial factors that measuring body composition can provide. (Science Behind Body Composition, A Withings Study)

 

“When patients lose weight, they are losing a combination of adipose (fat) tissue and lean body mass, which includes skeletal muscle mass, organ density and bone density. Ideally, we want patients to lose adipose tissue and preserve their lean body mass,” continued Kristin Baier, MD. Monitoring body composition over time is crucial, as changes and trends can provide valuable insights into a patient's health status — often more so than individual measurements.

Preventing muscle loss

One known side effect of GLP-1 medications is the loss of muscle mass along with body fat. If care teams only monitor patient progress using a standard scale, they won’t know if their patients are losing too much muscle mass too quickly. Some patients receive a one-time measurement of their body composition during their doctors’ office visit to determine if they’re eligible for a GLP-1 and sometimes during their annual checkup, so care teams are only seeing the data at the beginning and end of the patient journey. Other patients undergo treatment without any assessment of their body composition. By neglecting to measure aspects such as muscle mass, fat distribution, and hydration levels, healthcare providers may overlook crucial indicators that could impact treatment efficacy and patient well-being.

 

Muscle is important for burning calories and maintaining a healthy metabolism, which helps with long-term weight loss success. Loss of muscle mass is associated with an increased risk for lower bone density, fatigue, injuries, decreased strength, and more frequent hospitalizations. Preserving muscle is necessary not just to ensure ongoing physical movement but to protect against cancer, cardiovascular disease, and pulmonary disease. This can be tracked by using a GLP-1 remote patient monitoring to support the patient's journey.   

 

“By measuring body composition, we can accurately determine if this is, in fact, occurring. If we see that pounds are going down but their body fat percentage is staying the same and their muscle mass is decreasing, we can modify lifestyle components such as their type and frequency of exercise and food intake, for instance” shared Kristin Baier, MD.

Combatting GLP-1 agonist plateau

Although GLP-1 agonists tend to spark significant weight loss, most patients eventually reach a plateau in their weight and other metabolic markers like blood pressure. Focusing solely on weight or BMI can sometimes lead to short-term thinking and unsustainable weight loss strategies.

 

By helping patients focus less on specific weight numbers and more on changes in their body composition data, care teams can promote a more holistic approach that supports sustainable weight loss. 

For example, if a patient’s body weight increases or remains stable during treatment, GLP-1 remote patient monitoring and body composition monitoring may reveal that their body fat percentage has decreased while their muscle mass has increased. Although the individual is gaining weight in this scenario, it’s attributed to the growth of muscle tissue rather than an increase in body fat. This type of weight gain, known as lean mass gain, is generally considered positive for overall health and fitness as it can improve strength and metabolic rate.

Moving Forward

In a March 2024 survey conducted by Withings, patients taking GLP-1 medication were asked about the biomarkers they’ve been monitoring throughout their health journey. Among respondents, 37% highlighted body composition as a crucial metric they actively tracked using their Withings devices during their treatment regimen.

 

Write-in responses highlighted the value of regular body composition tracking in supporting healthy habits and addressing concerns about muscle loss.

"[My Withings scale] encouraged daily weigh-ins, identification of more clear lean body mass decrease, [and] increased focus on protein intake and resistance exercise per HCP guidance.” "I watch my muscle mass through the Withings scale. I don’t need my weight to decrease quickly, but I do want to keep or gain muscle.” "I was fearful that I would lose muscle, and the scale helped me to monitor.” "Daily reminder of weight, body composition, and BP (blood pressure) reinforced healthy eating and exercise goals."

Withings Body Pro 2 is an advanced body composition scale that accurately and reliably collects advanced patient biomarkers from the at-home setting and sends them directly to care teams via cellular connectivity.

 

Daily body composition analysis allows for a more personalized approach to treatment. Measuring patients’ body composition while on a GLP-1 therapy is important for assessing treatment effectiveness, monitoring metabolic health, preserving lean body mass, and ensuring overall health and safety for individuals undergoing this type of treatment.

Part 3: Discover the importance of remote monitoring devices after medication ends

Keep Reading [post_title] => Part 2: Supporting Safe and Sustainable Weight Loss With GLP-1s - Why body composition matters [post_excerpt] => GLP-1 agonists are remarkably effective in helping patients lose weight. But this can’t be done in a vacuum. One data point that’s often overlooked in a patient’s journey on GLP-1s is body composition. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => part-2-supporting-safe-and-sustainable-weight-loss-with-glp-1s-part-2-why-body-composition-matters [to_ping] => [pinged] => [post_modified] => 2024-06-27 09:56:59 [post_modified_gmt] => 2024-06-27 09:56:59 [post_content_filtered] => [post_parent] => 0 [guid] => https://withingshealthsolutions.com/?p=1150 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 1029 [post_author] => 1 [post_date] => 2024-02-01 07:15:00 [post_date_gmt] => 2024-02-01 07:15:00 [post_content] =>

SUMMARY

This case study explores how a virtual medical weight loss practice integrated a cellular remote patient monitoring scale into their program, improving the patient onboarding experience and reducing operational needs. 

Partner

FORM

Challenge

Needed a reliable and efficient weight tracking solutions that seamlessly integrated with existing workflow

Solution

Withings Body Pro Scale

Results

Reduced time spend technical troubleshooting and manual scale ordering needs by 20%

“Reducing support time is the biggest impact of partnering with Withings. Thanks to the quality of the Withings scale and level of partner support we don’t need additional staff to troubleshoot and support scale issues for our patients."

Derek Rowley, VP of Operations at FORM

BACKGROUND

FORM is a virtual medical weight loss practice that helps patients with obesity achieve their weight loss and health goals by combining evidence-based clinical care with cutting-edge technology. FORM patients work 1:1 with a dedicated physician and Registered Dietitian who provide a personalized weight loss plan that addresses nutrition, physical activity, and mindset shifts, along with a prescription for FDA-approved medication including GLP-1s, when appropriate. FORM provides all care virtually through its app where patients connect with their Care Team through video visits and messaging and access tools such as food journaling and weight tracking, along with educational resources, improving the patient onboarding and care. 

 

As part of their remote patient monitoring program which is billed through insurance, FORM patients are required to provide weight readings throughout the month. As a result, a scale is provided as part of their onboarding process. It is important that the scale is accurate and reliable to collect readings, as well as easy to use and engaging, so patients comply with the weight reading requirement.

CHALLENGE

FORM faced a challenge when they added remote patient monitoring as an offering given they needed to receive weight readings a minimum of 16 days each month to bill with specific CPT codes. They needed to make providing the weight readings easy for patients and looked for a scale vendor capable of digitally transmitting patient weight values, replacing their prior manual process where a patient sent a picture of the scale reading or typed in their value. Therefore, they required a reliable and efficient weight tracking solution that seamlessly integrated with their platform and existing workflow, for improving the patient onboarding.

 

FORM initially partnered with a cellular scale vendor and experienced a number of logistical and support challenges. The process of ordering scales was manual and tedious for their operations team and they experienced delayed shipments and inventory shortages. The vendor did not offer a dropship solution that could automate logistics and improve operational efficiency.

 

The logistical issues impacted the onboarding experience for FORM patients who often experienced long wait times for the scale to arrive, which meant their first visit with a FORM clinician could be delayed. Once they received the scale, some patients encountered connectivity issues and calibration challenges. When these technical issues arose, response time from the vendor was slow. It could take days for the FORM operations team to get troubleshooting tips from the prior vendor’s support team.

SOLUTION

FORM partnered with Withings Health Solutions to improve the FORM patient experience by including a high quality scale, automating logistics, and providing world-class scale support. 

 

With Withings Body Pro, FORM patients receive a trusted and brand-name cellular scale that is synonymous with high quality, ease of use, and reliability. The Withings scale enhances the FORM patient experience from onboarding and throughout the program.

 

A significant game-changer for the FORM operations team was integrating Withings' dropshipping capability, which eliminated inventory management responsibility for the FORM team, and streamlined logistics and the onboarding process. With Withings dropshipping capabilities, ordering a scale became as simple as the click of a button and the scale is delivered to patients within days.

"With Withings dropshipping, we've streamlined our scale shipments, making it incredibly easy for patients to start their program right away. We have confidence that the scale will arrive promptly and function reliably. We don’t want to have to think about inventory management and fulfillment - that’s not our game. Thanks to Withings' dropshipping capability, we can focus on other critical pieces of our onboarding experience."

Derek Rowley, VP of Operations at FORM.
body-pro-scale-lifestyle

FORM also integrated the Withings API into their specific workflow to ensure that when the patient steps on the scale their weight measurement flows directly to the FORM app, so that patients do not have to manually provide weight values, improving the patient onboarding. The scale’s body positioning feature helps patients know how to shift their body to get an accurate reading. Withings Body Pro scale has the ability to store readings offline and transmit the data once a connection is established, ensuring that no weight readings are ever lost due to connectivity issues, and making the patient data tracking more reliable and consistently transmitted to the FORM Care Team to act on.

RESULTS

The partnership between FORM and Withings Health Solution significantly enhanced their operational efficiency. The reduced time spent on troubleshooting technical issues and manual scale ordering opened up to 20% of their Enrollment Specialists’ time to focus on more value-added tasks. The once cumbersome process of scale troubleshooting has been reduced to no more than a couple of hours total a week.

 

With Withings dropshipping API integration, FORM patients receive their scale in a matter of days and can begin tracking their weight before their first appointment with their FORM clinician. This gets them in the habit of tracking their weight and, most importantly, allows them to start the program right away instead of experiencing delays after signing up. FORM clinicians receive the patient’s baseline weight data before their initial meeting which facilitates personalized treatment plans. The Withings dropshipping solution enables FORM to avoid the higher costs and inventory management risks that can exist when using a third-party fulfillment center or doing it themselves.

 

Higher reliability and consistency in data transmission was another major outcome in the partnership between FORM and Withings Health Solutions. “Overall our weight readings are more accurate and we receive them more consistently since we've partnered with Withings," said Jason Drapinski, Enrollment Specialist at FORM. With more consistent and reliable data transmission, FORM Care Teams can trust the data they receive, allowing for more accurate patient assessments, an improved patient onboarding experience and improved health outcomes.

20%

reduction in time spent troubleshooting technical issues and manual scale ordering 

Interested in partnering with us?

Contact Us

BACKGROUND

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Exploring the Surge in Remote GLP-1 Prescription Access

New medications like GLP-1 agonists offer a promising tool to help patients achieve a healthy weight. But supporting patients in long-term weight loss with GLP-1 remote patient monitoring involves more than medication. “Obesity is a complex, chronic medical condition that requires comprehensive care. GLP-1 medications are powerful tools in the obesity medicine toolkit, but they must be paired with lifestyle counseling and medical oversight for success & safety,” said Lauren Lemieux, MD, FACP, Dipl. ABOM at FORM, a virtual obesity medicine clinic that empowers patients with obesity to take control of their health through a personalized weight loss plan.

 

Uncertainties persist regarding the long-term effectiveness of these medications and the best approach to determine which patients can safely discontinue the medication while maintaining weight loss, and which patients would benefit from a prolonged therapy regimen. As we continue to learn more about GLP-1 agonists, daily measurement of biometrics such as weight, BMI, blood pressure, heart rate, sleep patterns, and body composition is particularly critical to making informed care decisions. 

 

The rise in remote prescribing of GLP-1 medications reflects a broader trend toward telemedicine and GLP-1 remote patient monitoring, which is driven by technological advancements and the need for increased care access. Healthcare teams continue to face challenges in treating and managing patients remotely, including:

 

  • Limited to no regular physical patient assessment 
  • Low patient engagement and communication in their treatment plan 
  • Technical issues with devices and unreliable data measurements 
  • Inability to correlate long-term data patterns with intervention strategies

Bridge the virtual care gap. Adopt smarter healthtech.

Care teams don’t always need more technology. They need smarter technology that improves their ability to provide better patient care. Withings offers a range of digital health solutions, from connected health devices like cellular scales and blood pressure monitors to an all-in-one self service remote patient monitoring platform. These solutions directly address many of the technological barriers of virtual care.

In a March 2024 survey, Withings asked their database of device users about their experience with GLP-1 treatments. Nearly a quarter of respondents reported taking GLP-1s, with a significant majority (93%) being prescribed healthy habits alongside their treatment. 60% of users noted biomarker changes associated with their GLP-1 regimen and 76% reported Withings products had a positive influence on their treatment journey. 

 

Withings newest cellular scale, Body Pro 2, combines habit-forming user features with a pioneering modular approach to manage chronic conditions like obesity. Its core capabilities allow care teams to capture advanced health metrics such as weight and body composition, while additional features can track advanced and clinically validated biomarkers typically only available in a professional setting. 

 

Withings Health Solutions simplifies access to long-term patient data, resulting in improved support GLP-1 remote patient monitoring and faster decision-making for treatments and care strategies.

Part 2: Learn why measuring body composition is key for patients on GLP-1s

Keep Reading [post_title] => Part 1: Supporting Safe and Sustainable Weight Loss With GLP-1s - Finding the right remote health technologies [post_excerpt] => New medications like GLP-1 agonists offer a promising tool to help patients achieve a healthy weight. But supporting patients in long-term weight loss involves more than medication. [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => supporting-safe-and-sustainable-weight-loss-with-glp-1s-part-1-finding-the-right-remote-health-technologies [to_ping] => [pinged] => [post_modified] => 2024-07-11 09:25:38 [post_modified_gmt] => 2024-07-11 09:25:38 [post_content_filtered] => [post_parent] => 0 [guid] => https://withingshealthsolutions.com/?p=1149 [menu_order] => 0 [post_type] => post [post_mime_type] => [comment_count] => 0 [filter] => raw ) [comment_count] => 0 [current_comment] => -1 [found_posts] => 3 [max_num_pages] => 1 [max_num_comment_pages] => 0 [is_single] => [is_preview] => [is_page] => [is_archive] => [is_date] => [is_year] => [is_month] => [is_day] => [is_time] => [is_author] => [is_category] => [is_tag] => [is_tax] => [is_search] => [is_feed] => [is_comment_feed] => [is_trackback] => [is_home] => 1 [is_privacy_policy] => [is_404] => [is_embed] => [is_paged] => [is_admin] => [is_attachment] => [is_singular] => [is_robots] => [is_favicon] => [is_posts_page] => [is_post_type_archive] => [query_vars_hash:WP_Query:private] => d6bdefb6de6359729a0a3bd126238704 [query_vars_changed:WP_Query:private] => [thumbnails_cached] => [allow_query_attachment_by_filename:protected] => [stopwords:WP_Query:private] => [compat_fields:WP_Query:private] => Array ( [0] => query_vars_hash [1] => query_vars_changed ) [compat_methods:WP_Query:private] => Array ( [0] => init_query_flags [1] => parse_tax_query ) )
Article

Part 1: Supporting Safe and Sustainable Weight Loss With GLP-1s – Finding the right remote health technologies

Read More
Article

Part 2: Supporting Safe and Sustainable Weight Loss With GLP-1s – Why body composition matters

Read More
Case Study

Improving the Patient Onboarding Experience and Reducing Scale Support Time for a Virtual Medical Weight Loss Program

Read More