MedPage Today
by Parker Brown August 22, 2014
Overweight patients with type 2 diabetes who were assigned diet and exercise goals reduced their healthcare costs by an average of more than $500 a year, a study found.
Over 10 years, their costs were 7% less than those given diabetes support and education alone, according to the study, published Thursday in the journal Diabetes Care.
“The most important takeaway is that if you’re overweight or obese and have diabetes, and are able to lose weight, you can put money back in your pocket,” said Mark Espeland, PhD, a professor of biostatistics at the Wake Forest School of Medicine, to MedPage Today.
The intervention was part of the Look AHEAD trial, which initially was to examine cardiovascular events but was stopped last year after lack of benefit regarding the primary endpoint.
The trial examined 5,121 individuals ages 45 to 76 at 16 different sites around the country. Those in the intervention group were assigned calorie, dietary fat, and physical activity goals over 10 years. The intervention led to reductions in hospitalizations (11%, P=0.004), hospital days (15%, P=0.01), and number of medications (6% P < 0.001) compared with participants who were invited to three sessions of diabetes support and education a year.
The reductions led to cost savings for hospitalization (10%, P=0.04) and medication (7%, P<0.001). The intervention led to a 10-year cost savings of $5,280 (95% CI 3,385-7,175) per person, or $528 per year.
Importantly, the benefit was not observed among individuals with a history of cardiovascular disease.
“Between the two groups, the intervention group and control group, there was very little difference in the costs associated with the routine medical care provided by the providers,” Espeland told MedPage Today.
“So both groups were seeing their clinicians and getting outpatient care, and at fairly comparable levels.”
The 11% overall decrease in costs was less than the 17% overall decrease in costs reported by the Diabetes Prevention Program for individuals initially free of diabetes. It was previously found that those in the Look AHEAD intervention group sustained a mean weight loss of 7.9 and 2.5 percentage points at 1 and 10 years, respectively.
The Look AHEAD cohort study upon which the findings were based has several limitations, the authors noted. All participants were required to have a usual source of medical care, so the findings may not be generalizable to other populations. The study relied on self-report.
Numerically there were fewer deaths in the intervention group (6.8% versus 7.8%) but that difference was not statistically significant (P=0.15). The authors didn’t assess healthcare costs related to these deaths.
Espeland disclosed relevant relationships with Terumo Medical Corporation, the Kowa Research Institute, Boehringer Ingelheim, and Takeda Global Research.