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Diabetes Prevention A Good Investment

A new study found that programs to prevent or delay type 2 diabetes make sound economic sense.

Nearly 26 million Americans have diabetes. It's the main cause of kidney failure, limb amputations and new-onset blindness in adults nationwide. It's also a major cause of heart disease and stroke. Diabetes costs the nation an estimated $174 billion per year, including $116 billion in direct medical costs and $58 billion in indirect costs like disability and work loss.

Type 2 diabetes accounts for up to 95% of diabetes cases. In 2002, the landmark Diabetes Prevention Program (DPP) clinical trial compared approaches to prevent diabetes in adults at high risk for the disease. This NIH-led study enrolled over 3,000 overweight or obese adults with blood sugar levels higher than normal but below the threshold for diabetes. The participants were randomly assigned to 1 of 3 groups. One received a lifestyle intervention aimed at a 7% weight loss and 150 minutes per week of moderate intensity activity. Another group received the oral diabetes drug metformin. The last received placebo pills.

After an average of 3 years, lifestyle changes that led to modest weight loss reduced the rate of type 2 diabetes by 58% compared to placebo. Metformin treatment reduced the rate of diabetes by 31%. When the researchers monitored participants for 7 more years, they continued to see lower rates of diabetes in the lifestyle and metformin groups. Lifestyle changes especially helped those aged 60 and older.

In the latest study, the research group examined the cost effectiveness of the different approaches. The analysis, funded primarily by NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other NIH components, appeared in the April 2012 issue of Diabetes Care.

The direct costs over 10 years for the lifestyle and metformin interventions were higher ($4,601 and $2,300 per participant) than for placebo ($769). But the costs of medical care received outside the DPP, including hospitalizations and outpatient visits, were higher for the placebo group ($27,468) than for the lifestyle ($24,563) or metformin ($25,616) groups.

Over 10 years, the combined costs of the interventions and medical care outside the study were lowest for metformin ($27,915) and higher for lifestyle ($29,164) than for placebo ($28,236). However, quality of life—measured by mobility, level of pain, emotional outlook and other indicators—was best for the lifestyle group throughout the study.

“The DPP demonstrated that the diabetes epidemic, with more than 1.9 million new cases per year in the United States, can be curtailed. We now show that these interventions also represent good value for the money,” says study chair Dr. David M. Nathan, director of the Diabetes Research Center at Massachusetts General Hospital.

“From the perspective of the health care payer, these approaches make economic sense,” says the study's lead author, Dr. William H. Herman, director of the Michigan Center for Diabetes Translational Research.