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, redmo001{at}umn.edu.
Abstract
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.
Footnotes
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↵*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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Clinical trial reg. no. NCT00017953, clinicaltrials.gov.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
- Received November 12, 2009.
- Accepted March 8, 2010.
- © 2010 by the American Diabetes Association.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
