Diabetes lifestyle counseling reduces meds and overall costs

Look AHEAD (Action for Health and Diabetes) is a multisite clinical trial of 5145 overweight or obese individuals with type 2 diabetes, age 45-76 years. Participants were randomly assigned to either intensive lifestyle intervention (which involved group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity) or to general diabetes support and education (DSE).

The mean age of the participants was 59 years, and 59% of participants were women. Medication costs declined by almost 10% in the lifestyle group and increased by 10% in the DSE group. The differences were greatest for diabetes medications: medication costs declined by 17% in the lifestyle group and increased by 11% in the DSE group. Furthermore, the intervention more than doubled the percentage of participants who achieved optimal care goals (from 11% to 24%) and at the same time reduced medication use and cost. A greater proportion in the DSE group also achieved optimal care goals at 1 year (increasing from 10% to 16%), but doing so required an increase in medication use and costs.

The current results have important implications for the cost-benefit ratio of providing lifestyle interventions; medication cost reductions must be factored in as an offset to the cost of the programs themselves. Perhaps lifestyle interventions can help bend the cost curve.

Diabetes Care. 2010;33:1153-1158