Diabetes prevention in India cost-feasible

By C. Vidyashankar, MD

CHENNAI (Reuters Health) - Lifestyle modifications and long-term treatment with metformin, alone or in combination, are cost-effective measures for preventing type 2 diabetes in individuals who are at risk for this disease, according to the results of a study by the Indian Diabetes Prevention Programme.

India is in the midst of a diabetes epidemic with around 35 million patients suffering from the disease, with roughly one third of that number likely undiagnosed cases, according to Dr. Ambady Ramachandran from the India Diabetes Research Foundation, Chennai, and his co-investigators. The findings are published in the current issue of Diabetes Care.

Ramachandran and his team evaluated the cost-effectiveness of lifestyle modifications and treatment with metformin, sold in the U.S. under the trade-name Glycophage and other names, in preventing diabetes in 531 adults between 35 and 55 years of age with impaired glucose tolerance.

The study population was divided into four groups: a lifestyle modification group that was advised to exercise daily for at least 30 minutes and given dietary advice; a metformin group given 250 mg tablets twice daily; a metformin and lifestyle modification group that received both interventions; and a control group that received standard health-care advice. The interventions were carried out over a 3-year period and subjects were monitored at regular intervals.

Effectiveness was measured as the "number needed to treat" to prevent one patient from progressing to full-blown diabetes, while the cost-effectiveness was calculated as the product of the effectiveness and the incremental costs involved for the duration of the study, the researchers explain.

While 55 percent of the control group progressed to diabetes, only around 40 percent of the intervention groups developed diabetes during the study period, the investigators found.

"Lifestyle modification was the most cost-effective intervention, followed by metformin," the researchers point out.

For the lifestyle group, the number of patients needed to treat, the cost of intervention per subject and the cost-effectiveness to prevent or delay one case of diabetes was 6.4, $225 and $1,052, respectively. The corresponding numbers for the metformin group were 6.9, $220, and $1,095.

Both these interventions postpone rather than prevent the onset of diabetes among high-risk individuals, Ramachandran told Reuters Health. "Postponing is equally good as it lengthens disease-free life," he added.

"Lifestyle modifications should be implemented first because it represents the best use of the resources," followed by metformin among non-responders, Ramachandran's team concludes.

SOURCE: Diabetes Care, October 2007.