The Effectiveness and Cost of Lifestyle Interventions Including Nutrition Education for Diabetes Prevention: A Systematic Review and Meta-Analysis

Abstract

Background Type 2 diabetes is a significant public health concern. With the completion of the Diabetes Prevention Program, there has been a proliferation of studies attempting to translate this evidence base into practice. However, the cost, effectiveness, and cost-effectiveness of these adapted interventions is unknown. Objective The purpose of this systematic review was to conduct a comprehensive meta-analysis to synthesize the effectiveness, cost, and cost-effectiveness of lifestyle diabetes prevention interventions and compare effects by intervention delivery agent (dietitian vs non-dietitian) and channel (in-person vs technology-delivered). Methods English and full-text research articles published up to July 2015 were identified using the Cochrane Library, PubMed, ERIC, CAB Direct, Science Direct and Google Scholar. Sixty-nine studies met inclusion criteria. Most employed both dietary and physical activity intervention components (four of 69 were diet-only interventions). Changes in weight, fasting and 2-hour blood glucose concentration, and hemoglobin A1c were extracted from each article. Heterogeneity was measured by the I^2 index, and study-specific effect sizes or mean differences were pooled using a random effects model when heterogeneity was confirmed. Results Participants receiving intervention with nutrition education experienced a reduction of 2.07 kg (95% CI: 1.52 to 2.62; p<0.001; I2=90.99%, 95% CI: 88.61% to 92.87%) in weight at 12 months with effect sizes over time ranging from small (0.17, 95% CI: 0.04 to 0.30; p=0.012; I2= 86.83%, 95% CI: 80.42% to 91.14%) to medium (0.65, 95% CI: 0.49 to 0.82; p<0.001; I2= 98.75%, 95% CI: 98.52% to 98.94). Effect sizes for 2-h blood glucose and HbA1c changes ranged from small to medium. The meta-regression analysis revealed a larger relative weight loss in dietitian-delivered interventions than in those delivered by non-dietitians (full sample: −1.0 kg; US subsample: −2.4 kg), and did not find statistical evidence that the delivery channel was an important predictor of weight loss. The average cost per kg weight loss ranged from $53.87 over 2 months to $1,005.36 over 12 months. The cost of intervention per participant delivered by dietitians was lower than interventions delivered by non-dietitians, though few studies reported costs. Conclusions Lifestyle interventions are effective in reducing body weight and glucose-related outcomes. Dietitian-delivered interventions, compared to those delivered by other personnel, achieved greater weight reduction. No consistent trend was identified across different delivery channels.

Cost-effectiveness of a faith-based lifestyle intervention for diabetes prevention among African Americans: A within-trial analysis

“…Although there is currently no widely accepted cost effectiveness threshold for reduction in weight or waist circumference, the results of this analysis are comparable to ICERs calculated for the same health effects in other studies. In a recent systematic review, Sun et al reported that the lowest average cost per kg weight loss was $34.06 over 6 months, while the highest was $1,005.36 over 12 months [11]. As expected, because of the high cost of HE and resulting small cost difference between FBAS and HE, the ICERs reported in this study were on the lower end of the range of ICERs from similar studies.…”

“…The meta-analysis, as a whole, concluded that programs can lower implementation costs and still achieve clinically significant weight loss, the single most important factor in reducing diabetes incidence [7]. However, there are few translation studies that have evaluated the cost-effectiveness of lifestyle interventions [7, 11]. There is an even greater paucity of research on the cost-effectiveness of lifestyle interventions targeting African Americans, a high-risk group.…”

A systematic review and meta-analysis of nutrition therapy compared with dietary advice in patients with type 2 diabetes

“…Compared with usual care, the effect of a lifestyle intervention on HbA1c was limited when baseline values was ,7.0% (53 mmol/mol). Furthermore, in a review of the effect of nutrition therapy in prediabetes, HbA1c declined w0.3 percentage points compared with the effect of usual care (19).…”

Online nutrition and T2DM continuing medical education course launched on state-level medical association

“…Specific to type 2 diabetes mellitus (T2DM), dietary intake plays a critical role in the management of the disease. Providing dietary and lifestyle education focused on T2DM has resulted in improved self-management and a reduction in both hemoglobin A1c (HbA1c) and 2-hour blood glucose levels 5–7…”