Bethesda, MD -- 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 the 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.
This issue was produced with support from UnitedHealth Foundation,
Novo Nordisk, and the New York State Health Foundation.
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.
- Deneen
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 YUSA
(formerly the YMCA) 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 and regular physical activity. UnitedHealth also launched
retail pharmacy-based programs across communities to help people
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
K. 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
urges 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.
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