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
- J. Bruce Redmon, MD1⇓,
- Alain G. Bertoni, MD2,
- Stephanie Connelly, MD3,
- Patricia A. Feeney, MA4,
- Stephen P. Glasser, MD5,
- Henry Glick, PHD6,
- Frank Greenway, MD7,
- Louise A. Hesson, MSN8,
- Michael S. Lawlor, PHD9,
- Maria Montez, MSHP10,
- Brenda Montgomery, RN11,
- the Look AHEAD Research Group*
- 1Division of Endocrinology, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota;
- 2Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina;
- 3Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee;
- 4Department of Biostatistics, Wake Forest University, Winston-Salem, North Carolina;
- 5Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama;
- 6Division of General Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;
- 7Clinical Trials, Pennington Biomedical Research Center of the Louisiana State University System, Baton Rouge, Louisiana;
- 8Weight and Eating Disorders Program, University of Pennsylvania, Philadelphia, Pennsylvania;
- 9Department of Economics, Wake Forest University, Winston-Salem, North Carolina;
- 10Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas;
- 11VA Puget Sound Health Care System and University of Washington, Seattle, Washington.
- Corresponding author: J. Bruce Redmon, .
OBJECTIVE 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.
RESEARCH DESIGN AND METHODS Look AHEAD is a multicenter randomized controlled trial of 5,145 overweight or obese individuals with type 2 diabetes, aged 45–76 years. An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity 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 online pharmacy.
RESULTS Participants randomized to an ILI had significantly greater improvements in CVD risk parameters and reduced medication use and cost compared with those assigned to DSE. At 1 year, average number of medications prescribed to treat CVD risk factors was 3.1 ± 1.8 for the ILI group and 3.6 ± 1.8 for the DSE group (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).
CONCLUSIONS At 1 year, ILI significantly improved CVD risk factors, while at the same time reduced medication use and cost. Continued intervention and follow-up will determine whether these changes are maintained and reduce cardiovascular risk.
↵*A complete list of the members of the Look AHEAD Research Group is available in an online appendix at http://care.diabetesjournals.org/cgi/content/full/dc09-2090/DC1.
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- Received November 12, 2009.
- Accepted March 8, 2010.
- © 2010 by the American Diabetes Association.
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