Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes

Mark A. Espeland, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC mespelan@wakehealth.edu.
Henry A. Glick, Weight and Eating Disorder Program, University of Pennsylvania, Philadelphia, PA.
Alain Bertoni, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC.
Frederick L. Brancati, Johns Hopkins School of Medicine, Baltimore, MD.
George A. Bray, Pennington Biomedical Research Center, Baton Rouge, LA.Follow
Jeanne M. Clark, Johns Hopkins School of Medicine, Baltimore, MD.
Jeffrey M. Curtis, Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM.
Caitlin Egan, Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, Providence, RI.
Mary Evans, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
John P. Foreyt, Department of Medicine, Baylor College of Medicine, Houston, TX.Follow
Siran Ghazarian, Roybal Comprehensive Health Center, Los Angeles, CA.
Edward W. Gregg, Centers for Disease Control and Prevention, Atlanta, GA.
Helen P. Hazuda, University of Texas Health Science Center at San Antonio, San Antonio, TX.
James O. Hill, Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO.
Don Hire, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
Edward S. Horton, Department of Clinical Epidemiology, Joslin Diabetes Center, Boston, MA.
Van S. Hubbard, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
John M. Jakicic, Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA.Follow
Robert W. Jeffery, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.Follow
Karen C. Johnson, Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN.
Steven E. Kahn, Department of Medicine, University of Washington, Seattle, WA.Follow
Tina Killean, Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM.
Abbas E. Kitabchi, Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN.
William C. Knowler, Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM.
Andrea Kriska, Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA.
Cora E. Lewis, Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
Marsha Miller, Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO.
Maria G. Montez, University of Texas Health Science Center at San Antonio, San Antonio, TX.
Anne Murillo, Department of Medicine, University of Washington, Seattle, WA.
David M. Nathan, Massachusetts General Hospital, Boston, MA.
Ebenezer Nyenwe, Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN.
Jennifer Patricio, Division of and Department of Medicine, St. Luke's-Roosevelt Hospital, New York, NY.
Anne L. Peters, Roybal Comprehensive Health Center, Los Angeles, CA.

Abstract

OBJECTIVE: To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial. RESEARCH DESIGN AND METHODS: A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes support and education (DSE). Use and costs of health-care services were recorded across an average of 10 years. RESULTS: ILI led to reductions in annual hospitalizations (11%, P = 0.004), hospital days (15%, P = 0.01), and number of medications (6%, P < 0.001), resulting in cost savings for hospitalization (10%, P = 0.04) and medication (7%, P < 0.001). ILI produced a mean relative per-person 10-year cost savings of $5,280 (95% CI 3,385-7,175); however, these were not evident among individuals with a history of cardiovascular disease. CONCLUSIONS: Compared with DSE over 10 years, ILI participants had fewer hospitalizations, fewer medications, and lower health-care costs.

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Diabetes care

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