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
Open accessAbstract
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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Despite modest weight losses from behavioral interventions, small weight losses can lead to impressive health improvements and risk factor reductions.
“Despite the modest weight losses associated with behavioral interventions, small weight losses can lead to impressive health improvements and risk factor reductions.”
From Maintenance of Lost Weight and Long-Term Management of Obesity (2018) · cites this paper as [87]
The Conclusions report weight loss alongside improvements in diabetes control, blood pressure, lipids, and other health measures. But the study concerns overweight or obese adults with type 2 diabetes, and its intervention combined weight loss with increased physical activity; it does not establish that small weight losses alone produce these improvements across behavioral interventions generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn the Look Ahead trial, 6% weight loss over eight years yielded improvements in cardiovascular risk factors, glycemic control, lipids, less medication usage, and reduced hospitalizations and healthcare costs.
“In the Look Ahead trial, 6% weight loss over eight years yielded improvements in a range of cardiovascular risk factors, including glycemic control and lipids, as well as less medication usage, and reduced hospitalizations and healthcare costs87,88.”
From Maintenance of Lost Weight and Long-Term Management of Obesity (2018) · cites this paper as [87]
The Conclusions (page unavailable) report improvements in diabetes-control markers and plasma lipids, as well as fewer hospitalizations, less medication use, and lower health-care costs with the intensive lifestyle intervention. They describe outcomes over 10 years, however, and do not establish that 6% weight loss over eight years yielded those benefits. The paper also notes that the intervention did not significantly reduce major cardiovascular events. (LLM, conf=0.88)
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- Authors
- Espeland, M. A., Glick, H. A., Bertoni, A., Brancati, F. L., Bray, G. A., Clark, J. M., Curtis, J. M., Egan, C., Evans, M., Foreyt, J. P., Ghazarian, S., Gregg, E. W., Hazuda, H. P., Hill, J. O., Hire, D., Horton, E. S., Hubbard, V. S., Jakicic, J. M., Jeffery, R. W., Johnson, K. C., Kahn, S. E., Killean, T., Kitabchi, A. E., Knowler, W. C., Kriska, A., Lewis, C. E., Miller, M., Montez, M. G., Murillo, A., Nathan, D. M., Nyenwe, E., Patricio, J., Peters, A. L., Pi-Sunyer, X., Pownall, H., Redmon, J. B., Rushing, J., Ryan, D. H., Safford, M., Tsai, A. G., Wadden, T. A., Wing, R. R., Yanovski, S. Z., & Zhang, P.
- Affiliations
- Wake Forest University Health Sciences (US)
- University of Pennsylvania (US)
- Johns Hopkins University (US)
- Pennington Biomedical Research Center (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Brown University (US)
- National Institutes of Health (US)
- Baylor College of Medicine (US)
- Roybal Comprehensive Health Center, Los Angeles, CA
- Centers for Disease Control and Prevention (US)
- The University of Texas at San Antonio Health Science Center (US)
- University of Colorado Health (US)
- Joslin Diabetes Center (US)
- University of Pittsburgh (US)
- University of Minnesota (US)
- University of Tennessee Health Science Center (US)
- University of Washington (US)
- University of Alabama at Birmingham (US)
- Massachusetts General Hospital (US)
- St. Luke's-Roosevelt Hospital Center (US)
- Division of and Department of Medicine, St. Luke’s-Roosevelt Hospital, New York, NY
- Corresponding author
- Espeland, Mark A.
- ORCID
- Espeland, Mark A.
- Bertoni, Alain
- Clark, Jeanne M.
- Evans, Mary
- Gregg, Edward W.
- Hazuda, Helen P.
- Hill, James O.
- Horton, Edward S.
- Jakicic, John M.
- Johnson, Karen C.
- Kahn, Steven E.
- Knowler, William C.
- Kriska, Andrea
- Lewis, Cora E.
- Nyenwe, Ebenezer
- Peters, Anne L.
- Pownall, Henry
- Redmon, J. Bruce
- Ryan, Donna H.
- Safford, Monika
- Tsai, Adam G.
- Wadden, Thomas A.
- Wing, Rena R.
- Yanovski, Susan Z.
- Zhang, Ping
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2014-08-07
- Volume
- 37
- Issue
- 9
- Pages
- 2548-2556
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4140155
- OpenAlex
- W2154794041
- Semantic Scholar
- ac9f3f7d4b516066b10f584b9111ef93ae455e26
- Cited by
- 174
- References
- 36
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 11 · 2023: 11 · 2022: 13 · 2021: 12 · 2020: 12 · 2019: 8 · 2018: 14 · 2017: 26 · 2016: 24 · 2015: 20 · 2014: 9
- FWCI
- 21.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR001120)
- National Institute of Diabetes and Digestive and Kidney Diseases (U01DK057149, R01DK081472, P30DK017047, P30DK079626)
- National Center for Advancing Translational Sciences
- National Institute on Minority Health and Health Disparities (P20MD006899)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- intensive lifestyle intervention, type 2 diabetes, obesity, overweight, health care costs, hospitalization, medication use, diabetes support and education, weight loss, cardiovascular disease history, Look AHEAD trial
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Health Services, Humans, Life Style, Male, Middle Aged, Obesity, Single-Blind Method, Health Care Costs, Overweight
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