Trimming pounds may cut health costs for diabetics

NEW YORK Thu Aug 28, 2014 5:09pm EDT

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NEW YORK (Reuters Health) – Overweight adults with diabetes who lost weight and kept it off lowered their average annual health care costs by more than $500, suggests a new study.

The 10-year Action for Health in Diabetes study claims to be the first to test whether a weight loss intervention can have an impact on the use and cost of healthcare services over the long term.

“It proved to be very effective - these folks lost weight and kept it off for 10 years,” said Mark Espeland, a researcher at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, who led the study.

Espeland told Reuters Health the savings were primarily due to fewer hospitalizations, fewer days in the hospital when someone was hospitalized and reductions in medication use and cost.

For the study, published in Diabetes Care, Espeland and his colleagues enrolled 5,121 obese and overweight people at 16 sites across the country, beginning in 2001.

The participants were all between the ages of 45 and 76 and had type 2 diabetes. Fifteen percent were overweight and the rest fell into the obese category, with 22 percent severely obese at the start of the study.

Half the participants were randomly assigned to follow an intensive lifestyle intervention (ILI) that included diet and exercise. The other half were given standard diabetes support and educational programs.

Espeland said that for the first six months, people in the ILI group had weekly group or individual meetings with nutritionists and behaviorists who offered support and encouragement.

The intervention group participants were also provided with meal replacements to help them meet their calorie goals and encouraged to exercise for the equivalent of about 175 minutes of walking per week, he said.

The study team tracked the participants’ medical histories for 10 years and found that people in the intervention group had 11 percent fewer hospitalizations than the comparison group. If ILI participants did go to the hospital, their stays were an average of 15 percent shorter. They also used fewer prescription medications over the study period.

The authors don’t report how much weight the participants lost or the cost of the intervention itself, noting they plan to publish the intervention’s cost-benefit analysis in a future study.

The annual cost of healthcare for participants in the intervention group was 7 percent less than healthcare costs for the comparison group. That added up to a savings of $5,280 per person over 10 years versus the comparison group.

The exception was participants who had a history of heart disease, for whom being in the intervention group was associated with $592 greater costs per person, per year, mainly in outpatient care.

For ILI participants without heart disease, the greatest savings came from fewer hospitalizations and less use of diabetes drugs and cholesterol-lowering drugs, the study authors note.

“We felt like these folks were just healthier and to the extent that medical care costs signal health, it looks like the weight loss intervention broadly improved the health of these individuals,” Espeland said.

He pointed out, however, that those savings occurred gradually over time.

“They weren’t there immediately so this is perhaps a slow moving process and it’s something that people have to stay with to get benefits from, but in the long run, it reduced costs,” Espeland said.

“I think healthcare systems should pay attention to the importance of lifestyle interventions based on the kind of cost savings and other outcomes you see in the study,” Dr. Patrick McBride, who was not involved in the study, told Reuters Health.

“A demonstration of decreased cost across hospitalizations, medications and other costs is really important to healthcare systems right now,” said McBride, who runs a diabetes prevention and management program at the University of Wisconsin Hospital in Madison.

McBride said that his program, called Active Living and Learning, is very similar to the intervention in the study. And it’s also been cost effective.

“It's estimated that the average person with diabetes costs the health system somewhere in the range of $75,000 per year or more, so anything that can reduce those costs is really important,” he said.

He added that the reduced healthcare costs could also benefit the patients financially. “There are co-pays for medication, co-pays and deductibles for clinic visits and hospital, so that should directly impact their pocketbook as well,” he said.

SOURCE: bit.ly/1q5UOIP Diabetes Care, online August 21, 2014.

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