Weight Loss Lowers Health Care Costs for Type 2 Diabetes

Losing weight may not only improve the health of overweight patients with type 2 diabetes, but may also significantly reduce their health care costs and needs, according to a new study in Diabetes Care.

Results showed an average annual cost savings of more than $500 per person among overweight patients with diabetes who shed pounds by dieting and increasing physical activity.
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“Lifestyle intervention can be a powerful approach to provide long-term benefits in health among overweight adults with type 2 diabetes,” says lead study author Mark A. Espeland, PhD, professor of public health sciences at Wake Forest Baptist Medical Center, in Winston-Salem, N.C. “The broad-based savings in health care needs and costs may be an additional motivation for patients to make lifestyle changes.”

Espeland and his colleagues studied 5,121 obese and overweight individuals with type 2 diabetes, ages 45 to 76, who participated in the Action for Health in Diabetes (Look AHEAD) study. Beginning in 2001, the study was conducted in 16 sites across the US.

Half of the participants at each site were randomized to either an intensive lifestyle intervention program or a diabetes support and education program—and their medical histories were tracked through 2012. Researchers observed costs savings in the lifestyle intervention group, due to decreased rates of hospitalization, fewer hospitalized days, and decreased need for prescription medications.

This group had 11% fewer hospitalizations and 15% shorter hospital stays, which factored into the overall average savings of $5,280 per person in health care costs over 10 years. The cost savings in this group were fairly consistent despite age, initial weight, gender, or ethnicity, according to the researchers.

Espeland says these benefits were not just limited to a few indications either. “We had the strongest evidence that rates of hospitalizations were lowered by the intervention for bone, cardiovascular, and pulmonary issues, but every class of hospitalizations we examined appeared to receive some benefit,” he says. “Similarly, medication use appeared to be reduced for a range of complications, including diabetes control, dyslipidemia, and hypertension.”  

The intervention in this group aimed to produce and sustain a 10% weight loss and 175 minutes per week of moderate physical activity. All participants had the same goals. “The benefits we saw in health care use and costs appeared to be broadly expressed across a range of patient subgroups,” Espeland says. “The one exception was that we did not see intervention-related savings among individuals with pre-existing cardiovascular disease.”

In general, researchers found that those in the lifestyle intervention group maintained lower weights and higher levels of physical activity throughout the study than those in the support and education group, which resulted in better control of their diabetes, blood pressure, sleep quality, physical function, and depression symptoms.

The researchers are continuing to assess health care use and costs among the Look AHEAD cohort. Because both of these variables tend to accelerate with aging, they want to understand how the intervention has affected later-life health care needs and costs. 

They are also working to determine the cost-benefit ratio of the project overall, assessing how the costs of providing the Look AHEAD intervention align with the cost savings it has realized for health care.

“We feel that the approaches we have taken to assess health care use and costs are a model for how the impact of other interventions on these outcomes should be assessed in clinical trials,” Espeland says. “We encourage research to find ways to deliver effective lifestyle interventions in the most cost-efficient manner.”

—Colleen Mullarkey

Reference

Espeland MA, Glick HA, Bertoni A, Brancati FL, Bray GA, Clark JM, et al. 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. Diabetes Care. 2014 Sep;37(9):2548-56.