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 The 10-year Action for Health in Diabetes study claims to be the
first to test whether a weight loss intervention can have an impact
on the use and cost of healthcare services over the long term.
“It proved to be very effective - these folks lost weight and kept
it off for 10 years,” said Mark Espeland, a researcher at Wake
Forest Baptist Medical Center in Winston-Salem, North Carolina, who
led the study.
Espeland told Reuters Health the savings were primarily due to fewer
hospitalizations, fewer days in the hospital when someone was
hospitalized and reductions in medication use and cost.
For the study, published in Diabetes Care, Espeland and his
colleagues enrolled 5,121 obese and overweight people at 16 sites
across the country, beginning in 2001.
The participants were all between the ages of 45 and 76 and had type
2 diabetes. Fifteen percent were overweight and the rest fell into
the obese category, with 22 percent severely obese at the start of
the study.
Half the participants were randomly assigned to follow an intensive
lifestyle intervention (ILI) that included diet and exercise. The
other half were given standard diabetes support and educational
programs.
Espeland said that for the first six months, people in the ILI group
had weekly group or individual meetings with nutritionists and
behaviorists who offered support and encouragement.
The intervention group participants were also provided with meal
replacements to help them meet their calorie goals and encouraged to
exercise for the equivalent of about 175 minutes of walking per
week, he said.
The study team tracked the participants’ medical histories for 10
years and found that people in the intervention group had 11 percent
fewer hospitalizations than the comparison group. If ILI
participants did go to the hospital, their stays were an average of
15 percent shorter. They also used fewer prescription medications
over the study period.
The authors don’t report how much weight the participants lost or
the cost of the intervention itself, noting they plan to publish the
intervention’s cost-benefit analysis in a future study.
The annual cost of healthcare for participants in the intervention
group was 7 percent less than healthcare costs for the comparison
group. That added up to a savings of $5,280 per person over 10 years
versus the comparison group.
The exception was participants who had a history of heart disease,
for whom being in the intervention group was associated with $592
greater costs per person, per year, mainly in outpatient care.
For ILI participants without heart disease, the greatest savings
came from fewer hospitalizations and less use of diabetes drugs and
cholesterol-lowering drugs, the study authors note.
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“We felt like these folks were just healthier and to the extent that
medical care costs signal health, it looks like the weight loss
intervention broadly improved the health of these individuals,”
Espeland said.
He pointed out, however, that those savings occurred gradually over
time.
“They weren’t there immediately so this is perhaps a slow moving
process and it’s something that people have to stay with to get
benefits from, but in the long run, it reduced costs,” Espeland
said.
“I think healthcare systems should pay attention to the importance
of lifestyle interventions based on the kind of cost savings and
other outcomes you see in the study,” Dr. Patrick McBride, who was
not involved in the study, told Reuters Health.
“A demonstration of decreased cost across hospitalizations,
medications and other costs is really important to healthcare
systems right now,” said McBride, who runs a diabetes prevention and
management program at the University of Wisconsin Hospital in
Madison.
McBride said that his program, called Active Living and Learning, is
very similar to the intervention in the study. And it’s also been
cost effective.
“It's estimated that the average person with diabetes costs the
health system somewhere in the range of $75,000 per year or more, so
anything that can reduce those costs is really important,” he said.
He added that the reduced healthcare costs could also benefit the
patients financially. “There are co-pays for medication, co-pays and
deductibles for clinic visits and hospital, so that should directly
impact their pocketbook as well,” he said.
SOURCE: http://bit.ly/1q5UOIP
Diabetes Care, online August 21, 2014.
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