Impact of an Intensive Lifestyle Intervention on Use and Cost of Medical Services Among Overweight and Obese Adults With Type 2 Diabetes: The Action for Health in Diabetes

Author:

Espeland Mark A.1,Glick Henry A.2,Bertoni Alain3,Brancati Frederick L.4,Bray George A.5,Clark Jeanne M.4,Curtis Jeffrey M.67,Egan Caitlin8,Evans Mary9,Foreyt John P.10,Ghazarian Siran11,Gregg Edward W.12,Hazuda Helen P.13,Hill James O.14,Hire Don1,Horton Edward S.15,Hubbard Van S.9,Jakicic John M.16,Jeffery Robert W.17,Johnson Karen C.18,Kahn Steven E.19,Killean Tina67,Kitabchi Abbas E.18,Knowler William C.67,Kriska Andrea16,Lewis Cora E.20,Miller Marsha14,Montez Maria G.13,Murillo Anne19,Nathan David M.21,Nyenwe Ebenezer18,Patricio Jennifer22,Peters Anne L.11,Pi-Sunyer Xavier22,Pownall Henry10,Redmon J. Bruce17,Rushing Julia1,Ryan Donna H.5,Safford Monika20,Tsai Adam G.23,Wadden Thomas A.2,Wing Rena R.8,Yanovski Susan Z.9,Zhang Ping12

Affiliation:

1. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC

2. Weight and Eating Disorder Program, University of Pennsylvania, Philadelphia, PA

3. Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC

4. Johns Hopkins School of Medicine, Baltimore, MD

5. Pennington Biomedical Research Center, Baton Rouge, LA

6. Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ

7. Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM

8. Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, Providence, RI

9. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD

10. Department of Medicine, Baylor College of Medicine, Houston, TX

11. Roybal Comprehensive Health Center, Los Angeles, CA

12. Centers for Disease Control and Prevention, Atlanta, GA

13. University of Texas Health Science Center at San Antonio, San Antonio, TX

14. Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO

15. Department of Clinical Epidemiology, Joslin Diabetes Center, Boston, MA

16. Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA

17. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

18. Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN

19. Department of Medicine, University of Washington, Seattle, WA

20. Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL

21. Massachusetts General Hospital, Boston, MA

22. Division of and Department of Medicine, St. Luke’s-Roosevelt Hospital, New York, NY

23. Division of Internal Medicine, University of Colorado Health Sciences Center, Aurora, CO

Abstract

OBJECTIVE To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial. RESEARCH DESIGN AND METHODS A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes support and education (DSE). Use and costs of health-care services were recorded across an average of 10 years. RESULTS ILI led to reductions in annual hospitalizations (11%, P = 0.004), hospital days (15%, P = 0.01), and number of medications (6%, P < 0.001), resulting in cost savings for hospitalization (10%, P = 0.04) and medication (7%, P < 0.001). ILI produced a mean relative per-person 10-year cost savings of $5,280 (95% CI 3,385–7,175); however, these were not evident among individuals with a history of cardiovascular disease. CONCLUSIONS Compared with DSE over 10 years, ILI participants had fewer hospitalizations, fewer medications, and lower health-care costs.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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