Efforts to prevent type 2 diabetes in persons at high risk for developing it improve quality of life and may save money, according to data presented by researchers at the American Diabetes Association’s 71st Scientific Sessions®.
The 10-year cost-effectiveness analysis, a follow-up to the landmark National Institutes of Health-sponsored Diabetes Prevention Program (DPP), found that treatment with metformin or a lifestyle intervention reduced the costs of medical care by $1700 and $2600 per person, respectively, over 10 years compared to placebo. The cost reductions included lower costs for inpatient and outpatient care and prescriptions. The study found that the lifestyle intervention arm cost more to administer than metformin or placebo. When the reductions in the costs of medical care were balanced against the costs of the interventions, metformin saved $30 while the lifestyle intervention cost $1500 per person over the entire 10 years. The lifestyle intervention, which aimed for a 7 percent loss in body weight and 150 minutes per week of moderate intensity activity, cut the rates of progression to diabetes nearly twice as often as treatment with metformin. The lifestyle intervention also resulted in greater improvement in quality of life than either metformin or placebo. Pairing the costs of care with measures of health and quality of life, both interventions were found to be highly cost-effective.
The findings, reported by William H. Herman, MD, MPH, Professor of Medicine and Epidemiology at the University of Michigan and co-investigator of the DPP Research Group, are particularly significant because it is so rare for a health intervention to simultaneously improve health and save money.
“This puts diabetes prevention in the category of prenatal care or pediatric immunizations,” said Herman. “It’s dramatic when an intervention can improve the health of the population and potentially save money at the same time.”
In the DPP, overweight and obese participants with impaired glucose tolerance were randomly assigned to lifestyle intervention, metformin or placebo groups. Initial results reported in 2002 showed that lifestyle intervention led to a 58% reduction in the development of diabetes, from about 11% per year to about 5% per year. Metformin resulted in a 31% reduction in diabetes development. During the next seven-year follow-up period, when all participants were offered a less intensive lifestyle intervention and metformin-treated patients were encouraged to continue the medication, the effectiveness of both treatments was somewhat
diminished, with 34% and 18% reductions in diabetes development over the entire ten years with lifestyle intervention and metformin, respectively.
“The DPP has shown that lifestyle intervention and metformin can decrease the epidemic of diabetes that is currently affecting the U.S. and much of the world and, in doing so, may save money,” noted David M. Nathan, MD, the DPP Chairman and a Professor of Medicine at Harvard Medical School. “The cost-savings may seem modest now, but any decrease in medical costs is welcome and the savings may very well increase in the future.” The DPP investigators concluded that health care and societal policies should support the use of lifestyle intervention and metformin to prevent or delay diabetes.
“Currently, there are 79 million people in the U.S. living with prediabetes who could greatly benefit from policies that help prevent diabetes among those at high risk,” said Griffin P. Rodgers, MD, Director of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health and the major sponsor of the DPP. “The investment in clinical research studies, such as the DPP, can pay tremendous dividends in terms of greater public health and long-term cost savings from reduced medical costs. Translating these findings into practice will reduce the development of type 2 diabetes, which has become one of the most common and costly diseases in the U.S. and around the world.”
# # #
Symposium Tuesday, June 28, 9:45-11:45 a.m. PDT
The American Diabetes Association is leading the fight to stop diabetes and its deadly consequences and fighting for those affected by diabetes. The Association funds research to prevent, cure and manage diabetes; delivers services to hundreds of communities; provides objective and credible information; and gives voice to those denied their rights because of diabetes. Founded in 1940, our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. For more information please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit www.diabetes.org. Information from both these sources is available in English and Spanish.