Associations of Intensive Lifestyle Intervention in Type 2 Diabetes With Health Care Use, Spending, and Disability

Abstract

IMPORTANCE Intensive lifestyle interventions focused on diet and exercise can reduce weight and improve diabetes management. However, the long-term effects on health care use and spending are unclear, especially for public payers. OBJECTIVE To estimate the association of effective intensive lifestyle intervention for weight loss with long-term health care use and Medicare spending. DESIGN, SETTING, AND PARTICIPANTS This ancillary study used data from the Look AHEAD randomized clinical trial, which randomized participants with type 2 diabetes to an intensive lifestyle intervention or control group (ie, diabetes support and education), provided ongoing intervention from 2001 to 2012, and demonstrated improved diabetes management and reduced health care costs during the intervention. This study compared Medicare data between study arms from 2012 to 2015 to determine whether the intervention was associated with persistent reductions in health care spending. EXPOSURE Starting in 2001, Look AHEAD's intervention group participated in sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists with the goal of reducing weight 7% in the first year. Sessions occurred weekly in the first 6 months of the intervention and decreased over the intervention period. The controls participated in periodic group education sessions that occurred 3 times per year in the first year and decreased to 1 time per year later in the trial. MAIN OUTCOMES AND MEASURES Outcomes included total Medicare spending, Part D prescription drug costs, Part A and Part B Medicare spending, hospital admissions, emergency department visits, and disability-related Medicare eligibility. RESULTS This study matched Medicare administrative records for 2796 Look AHEAD study participants (54% of 5145 participants initially randomized and 86% of 3246 participants consenting to linkages). Linked intervention and control participants were of a similar age (mean [SD] age, 59.6 [5.4] years vs 59.6 [5.5] years at randomization) and sex (818 [58.1%] women vs 822 [59.3%] women). There was no statistically significant difference in total Medicare spending between groups

Diet Management of Patients with Chronic Kidney Disease in Bariatric Surgery

“…For CKD patients, intake can be higher, especially in dialysis patients. The Look AHEAD study showed the benefits of using a reducing diet of 1200–1800 kcal in adult patients with DM2 and GFR < 60 mL/min/1.73 m 2 and albumin/creatinine ratio (ACR) > 30 mg/g [ 82 ].…”

A data-driven approach to manage type 2 diabetes mellitus through digital health: The Klivo Intervention Program protocol (KIPDM)

“…Some studies have suggested that continuous remote evaluation and daily monitoring can effectively refine the management of chronic conditions such as type 2 diabetes mellitus (T2DM), which has a high prevalence and social and economic burden [2,3]. In this sense, digital therapeutics products addressed to patients' individual needs have contributed to ongoing management of daily life habits and to lowering healthcare costs attributed to chronic metabolic diseases [4,5].…”

Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes

“…Multidomain intensive lifestyle intervention (ILI; providing counseling and support for behavioral change and goal setting, healthy diet, and increased physical activity) is recommended for the prevention and management of type 2 diabetes, particularly among persons who have overweight or obesity . Strong evidence suggests that multidomain ILI reduces cardiovascular risk factors among persons with type 2 diabetes across North America, Europe, and Asia, but it is less clear whether ILIs are cost-effective …”

“…[2][3][4] Strong evidence suggests that multidomain ILI reduces cardiovascular risk factors among persons with type 2 diabetes across North America, Europe, and Asia, but it is less clear whether ILIs are cost-effective. [5][6][7][8][9] Assessing whether any intervention for type 2 diabetes is worth the cost requires considering the effects on labor productivity. By improving physical function and mental health, lifestyle interventions could have positive effects on labor market participation, productivity at work, and earnings.…”