Reducing Cost and Risks for Cardiovascular Disease

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….

The study was to examine the effect of a lifestyle intervention to produce weight loss and increased physical fitness on use and cost of medications to treat cardiovascular disease (CVD) risk factors in people with Type 2 diabetes.

The study was titled ” Look AHEAD” and is a multi-center randomized controlled trial of 5,145 overweight or obese individuals with Type 2 diabetes, aged 45-76 years. An intensive lifestyle intervention involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity (ILI) was compared with a diabetes support and education (DSE) condition. Medications prescribed to treat diabetes, hypertension and hyperlipidemia were compared at baseline and 1-year. Medication costs were conservatively estimated using prices from a national on-line pharmacy.

Participants randomized to ILI had significantly greater improvements in CVD risk parameters and reduced medication use and cost compared to DSE. At 1-year, average number of medications prescribed to treat CVD risk factors was 3.1 for ILI and 3.6 for DSE (P<0.0001) with estimated total monthly medication costs of $143 and $173, respectively (P<0.0001). DSE participants meeting optimal care goals at 1-year were taking an average of 3.8±1.6 medications at an estimated cost of $194/month. ILI participants at optimal care required fewer medications (3.2±1.7) at lower cost ($154/month) (P<0.001).

In conclusion, compared to a program of general diabetes support and education, the Look AHEAD study intensive lifestyle intervention program after one year resulted in greater improvements in diabetes, blood pressure and lipid parameters while at the same time reducing prescription medication requirements and cost. These benefits were seen for both the total study cohort as well as the subgroup of participants who met optimal care goals for the CVD risk triad of diabetes, hypertension and hyperlipidemia. Those participants meeting optimal care goals took more medications with higher cost compared to the overall study cohort, but like the total study cohort, their medication requirements and costs were substantially reduced by the study intervention. If these changes can be sustained for the long term, the public health benefits would be substantial.

The total cost of diabetes in the US in 2007 is estimated at $174 billion with $25 billion of this cost attributed to outpatient retail prescriptions. Diabetes medications and supplies and medications to treat the complications of diabetes are estimated at 25% of the medical expenses attributed to diabetes, making this the second largest single cost after hospital inpatient care. An effective, long-term lifestyle intervention for people with Type 2 diabetes which simultaneously reduces cardiovascular risk parameters and prescription medication cost would have major public health implications.

Diabetes Care published online April 5, 2010