Diabetes now affects nearly twenty-six million Americans, and over the next decade, an estimated forty million more US adults could develop the condition. Another 100 million more could suffer from an insidious prediabetic condition, one that often leads to the full-blown disease. Growing scientific evidence suggests that lifestyle interventions, such as weight loss and fitness programs, can prevent or delay the development of type 2 diabetes that is often triggered by excess weight. But will lifestyle interventions lead to sustained weight loss, and do they really save money in the long run?
The January issue of Health Affairs explores the many facets of this complex problem and the challenges to be overcome to curb diabetes. If nothing is done, the surge in new cases could add an estimated $512 billion to nation’s annual health care spending by the year 2021, according to one of the articles in this month’s Health Affairs, by Deneen Vojta and colleagues at UnitedHealth Group.
Lifestyle Programs: How Much Can They Impact Type 2 Diabetes And Its Consequences?
Four papers add to the scientific evidence suggesting that lifestyle programs can effectively prevent or stave off the disease.
- Vojta and colleagues at UnitedHealth Group say that multiple clinical trials show that seriously overweight or obese people who lose from 5 to 7 percent of body weight can prevent progression of a condition known as prediabetes to full-blown diabetes. However, interventions aimed at helping people lose weight have not been implemented on a broad scale. The authors conclude that, to avert an even worse situation, the nation should enroll high-risk people in proven models that encourage sustained weight loss and lifelong fitness habits. UnitedHealth Group, in partnership with the YMCA of the USA (Y-USA) and the Centers for Disease Control and Prevention recently launched community-based programs that help people at risk of diabetes adopt a healthier lifestyle encompassing healthier eating s and regular physical activity. UnitedHealth also launched retail pharmacy-based programs across communities to help eople with diabetes adopt healthier behaviors.
- An analysis by Xiaohui Zhuo and Ann Albright at the Centers for Disease Control and Prevention, and coauthors, suggests that instituting a national program of community-level lifestyle interventions to prevent type 2 diabetes would constitute an efficient use of resources. The authors projected the costs and benefits of such a nationwide intervention through a computer simulation model. They estimated that within twenty-five years, such a program could prevent or delay the onset of about 885,000 cases of type 2 diabetes. After factoring in initial start-up costs, they concluded that the program would save the US health care system an estimated $5.7 billion.
- Can lower-cost intervention programs that are modeled on the Diabetes Prevention Program trial motivate people to lose weight in real-life settings? Mohammed Ali and colleagues at Emory University addressed this question by conducting a systematic review and meta-analysis of twenty-eight studies. They found that a year after enrollment in lifestyle intervention programs, the average participant had lost about 4 percent of baseline body weight, an amount that may offer diabetes protection. The weight loss was the same regardless of whether the program relied on higher-salaried health professionals or lower-cost lay staff who are trained to deliver healthy eating and fitness advice. The authors conclude that motivating higher session attendance was an important driver of success.
- According to Kenneth Thorpe at Emory University, flaws in the current health care system often lead to fragmented and expensive care for chronic conditions, including type 2 diabetes. The author urge policy makers to build on several provisions in the Affordable Care Act to create a national, coordinated public health treatment and prevention program for diabetes—one that could be used to combat obesity and other chronic conditions as well.
The Limits Of Lifestyle Interventions And The Benefits Of Medical Management of Diabetes
Two papers point out the limitations inherent in lifestyle intervention programs to prevent or treat type 2 diabetes. Their authors argue that, for now, it may be smarter to focus on better treatment and management of the disease, which can deliver such benefits as the reduced risk of complications.
- Although studies have shown that weight loss delays or prevents diabetes, most people regain the weight after the trial stops, writes Richard Kahn at the University of North Carolina. He argues that prevention efforts won’t work unless we know more about the complex factors underlying the biology of energy intake and expenditure. Also, in an environment where food is plentiful and inexpensive, we need populationwide strategies to reduce overall energy consumption. In the meantime, the author concludes, we could easily improve the medical management of diabetes, thereby greatly reducing complications resulting from the disease.
- An analysis by Bradley Gray at the American Board of Internal Medicine and colleagues looked at which interventions made the most difference in the health of diabetes patients: those that are more controlled by physicians, such as prescribing medicine for high blood pressure, or those that are more controlled by patients, such as eating a diet recommended for diabetes patients or undergoing weight loss. Using a well-known computer model, the authors simulated a thirty-year clinical trial to find the answers. They found that if the entire population of all US patients diagnosed with diabetes met aggressive targets for lowering blood pressure, LDL cholesterol. and blood glucose levels, they would benefit more than if they complied fully with dietary recommendations, although diet remained an important factor. The authors say their research highlights the fact that physicians have a substantial opportunity to improve the health of their diabetes patients by working with them to meet these aggressive “biomarker” targets.
This issue was produced with support from UnitedHealth Foundation, Novo Nordisk, and the New York State Health Foundation.