Diabetic Lifestyle Interventions Reduced Hospitalizations, Medications and Costs

Mark A. EspelandMedicalResearch.com Interview with:
Mark A. Espeland PhD Professor
Department of Biostatistics
Sticht Center on Aging Center for Diabetes Research
WFU Primate Center Center for Integrative Medicine
Translational Science Institute
Wake Forest School of Medicine, Winston-Salem, NC

Medical Research: What are the main findings of the study?

Dr. Espeland : Over 10 years, overweight and obese adults with type 2 diabetes who were provided a lifestyle intervention targeting sustained weight loss and increased physical activity, lowered their rates of hospitalizations and medication use and reduced the costs of their health care by over $5,000.
Medical Research: Were any of the findings unexpected?

Dr. Espeland : We were surprised by several findings:

  • First, the reductions in hospitalizations and medication requirements were broadly expressed across a spectrum of complications, not just linked to the improvements in diabetes control and risk factors we had previously reported.
  • Second, in an earlier publication we reported that the intervention did not reduce the incidence of major cardiovascular events, yet we found that it reduced the overall rates and costs of hospitalizations related to cardiovascular disease
  • We also found that savings were broadly realized across major groups of patients, with one exception:  the intervention did not reduce health care costs among those with pre-existing cardiovascular disease.

Medical Research: What should clinicians and patients take away from your report?

Dr. Espeland : Lifestyle interventions can be effective approaches to provide long-term general health benefits among overweight adults with type 2 diabetes.  It may be best to begin these early, before cardiovascular disease occurs.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Espeland : We are working towards assessing how the costs of providing the Look AHEAD intervention align with the cost savings it realized for health care, i.e. to project cost-benefit.  We are also continuing to asses health care use and costs among the Look AHEAD cohort:  these tend to accelerate with aging and we want to understand how the intervention has affected later-life health care needs and costs.  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.  We encourage research to find ways to deliver effective lifestyle interventions in the most cost-efficient manner.


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 September 2014 37:9 25482556; doi:10.2337/dc14-0093 1935-5548
Mark A. Espeland, Henry A. Glick, Alain Bertoni, et al, for the Look AHEAD Research Group

Diabetes Care September 2014 37:9 25482556; doi:10.2337/dc14-0093 1935-5548