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Lifestyle Counseling Can Reduce Medications and Costs in Diabetes

Effect of the Look AHEAD Study Intervention on Medication Use and Related Cost to Treat Cardiovascular Disease Risk Factors in Individuals with Type 2 Diabetes

Redmon JB, Bertoni AG, Connelly S, et al;
Look AHEAD Research Group
Diabetes Care. 2010;33:1153-1158

Study Summary

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 goal is to study the effects on cardiovascular morbidity and mortality. In the current analysis, use of medications prescribed to treat diabetes, hypertension, and hyperlipidemia and the costs of those medications were compared at baseline and 1 year. All participants were required to have a primary care clinician who was responsible for any necessary changes in medications. Costs were conservatively estimated through the use of generic drug costs (when available) and the assumption that patients were using about 50% of the maximum dose. In addition to analyses of all participants, a subanalysis of participants who met optimal care goals for diabetes, blood pressure, and lipid control was also conducted.

The mean age of the participants was 59 years, and 59% of participants were women. At baseline, participants in both groups averaged 3.3 prescriptions per month at a mean cost of about $156. After 1 year, medication use for intensive lifestyle intervention was significantly lower than for DSE (3.1 vs. 3.6; P

Viewpoint by Gregory A. Nichols, PhD

The Look AHEAD investigators recently reported beneficial effects of 1 year of intensive lifestyle intervention on weight loss, glycemic control, and cardiovascular risk factors.[1] This, of course, has important implications for long-term morbidity and mortality. In the short term, however, the current study demonstrates that intensive lifestyle intervention can reduce medication use and costs, both of which could be a far stronger motivation for individual patients to undertake lifestyle changes than a small decrease in A1c levels. Furthermore, because lifestyle interventions reduce diabetes incidence among at-risk patients well after the active interventions have ceased,[2-4] the current findings could be extrapolated to suggest that glycemic control among patients with diagnosed diabetes may also endure beyond active intervention. Even if it doesn’t, long-term follow-up of the United Kingdom Prospective Diabetes Study showed a reduction in microvascular complications, myocardial infarction, and all-cause mortality risk even though glycemic control differences between intensive and standard control groups later equalized.[5] Thus, if possible reductions in medication use and cost can indeed motivate patients to make lifestyle changes, the long-term goals of better health and quality of life can still be achieved. Furthermore, 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.

References
1.Pi-Sunyer X, Blackburn G, Brancati FL, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care. 2007;30:1374-1383.
2.Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet. 2006;368:1673-1679.
3.Diabetes Prevention Program Research Group. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009;374:1167-1186.
4.Li G, Zhang P, Wang J, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabets Prevention Study: a 20-year follow-up study. Lancet. 2008;371:1783-1789.
5.Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes.

Sources include:
http://www2.niddk.nih.gov/Research/ScientificAreas/Obesity/ClinicalStudies/AHEAD.htm
http://www.medscape.com/viewarticle/724315?src=rss
http://www.kpchr.org/research/public/investigators.aspx?InvID=25
http://care.diabetesjournals.org/

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