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

  1. Ping Zhang12
  2. for the Look AHEAD Research Group
  1. 1Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
  2. 2Weight and Eating Disorder Program, University of Pennsylvania, Philadelphia, PA
  3. 3Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
  4. 4Johns Hopkins School of Medicine, Baltimore, MD
  5. 5Pennington Biomedical Research Center, Baton Rouge, LA
  6. 6Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ
  7. 7Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM
  8. 8Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, Providence, RI
  9. 9National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
  10. 10Department of Medicine, Baylor College of Medicine, Houston, TX
  11. 11Roybal Comprehensive Health Center, Los Angeles, CA
  12. 12Centers for Disease Control and Prevention, Atlanta, GA
  13. 13University of Texas Health Science Center at San Antonio, San Antonio, TX
  14. 14Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO
  15. 15Department of Clinical Epidemiology, Joslin Diabetes Center, Boston, MA
  16. 16Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
  17. 17Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
  18. 18Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN
  19. 19Department of Medicine, University of Washington, Seattle, WA
  20. 20Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
  21. 21Massachusetts General Hospital, Boston, MA
  22. 22Division of and Department of Medicine, St. Luke’s-Roosevelt Hospital, New York, NY
  23. 23Division of Internal Medicine, University of Colorado Health Sciences Center, Aurora, CO
  1. Corresponding author: Mark A. Espeland, mespelan{at}wakehealth.edu.
  • Deceased.

Abstract

OBJECTIVE To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial.

RESEARCH DESIGN AND METHODS A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes support and education (DSE). Use and costs of health-care services were recorded across an average of 10 years.

RESULTS ILI led to reductions in annual hospitalizations (11%, P = 0.004), hospital days (15%, P = 0.01), and number of medications (6%, P < 0.001), resulting in cost savings for hospitalization (10%, P = 0.04) and medication (7%, P < 0.001). ILI produced a mean relative per-person 10-year cost savings of $5,280 (95% CI 3,385–7,175); however, these were not evident among individuals with a history of cardiovascular disease.

CONCLUSIONS Compared with DSE over 10 years, ILI participants had fewer hospitalizations, fewer medications, and lower health-care costs.

Footnotes

  • Received January 12, 2014.
  • Accepted March 6, 2014.
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