Issue 174 Item 6 Preventing Type 2 Diabetes Saves $$$60,000/Patient

A 7% weight loss combined with 150 minutes or more of physical activity per week reduced the incidence of type 2 diabetes by 58%.

Routine implementation of moderate weight loss and physical activity in patients with impaired glucose tolerance wouldn’t be merely cost-effective, it would actually save money in the long term while improving health outcomes, Dr. William Herman said at the annual scientific sessions of the American Diabetes Association.

Moreover, daily use of metformin in patients with impaired glucose tolerance (IGT) probably would save money as well. “Health policy should promote implementation of weight loss, physical activity, and metformin in high-risk individuals” with IGT, said Dr. Herman, professor of medicine at the University of Michigan, Ann Arbor.

His findings were based on an economic analysis of the interventions used in the Diabetes Prevention Program (DPP), a randomized, multicenter trial of 3,234 subjects with IGT to receive standard lifestyle recommendations plus metformin (1,073 subjects), standard lifestyle recommendations plus placebo (1,082), or an intensive lifestyle intervention (1,079). Published last year, the DPP showed that a 7% weight loss combined with 150 minutes or more of physical activity per week reduced the incidence of type 2 diabetes by 58% at a mean of 2.8 years’ follow-up. Metformin (Glucophage, taken 850 mg b.i.d.) reduced the incidence by 31% compared with standard medical care (N. Engl. J. Med. 346[6]:393-403, 2002).

The new cost analysis also suggests that even in a more real-life scenario—in which lifestyle intervention is delivered in a group setting, generic metformin is used, and both are 20% less effective than they were in the DPP—both interventions would still be cost-saving over a lifetime, he said.

The economic analysis used assumptions based on previously published data on the costs of each DPP intervention (Diabetes Care 26[1]:36-47, 2003), along with epidemiologic data on the progression of complications of type 2 diabetes. The DPP incidence data used were those of a follow-up at 3.2 years, in which the reductions were slightly lower than what was published (55% for lifestyle intervention and 30% for metformin).

Lifetime direct medical costs—including those of the intervention plus treatment of diabetes and its complications among those who progress to the disease—would be $59,917 for subjects in the lifestyle intervention group, $64,871 with Glucophage, and $63,440 for placebo. Compared with placebo, that represents a savings of $3,523 with lifestyle intervention and an additional expenditure of $1,431 with the brand-name drug, as was used in the DPP.

DID YOU KNOW:
Pioglitazone Decreases Dense LDL in Non-Diabetic Hypertensives:
Pioglitazone significantly reduces dense LDL independent from fasting triglycerides and HDL cholesterol and theantiatherogenic potential may be greater than that expected from its effectos n trigclyerides, LDL, and HDL cholesterol alone. Diabetes Care 2003;26:9:2588-2594

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