Intervention participants had significant reductions in weight and HbA1c but there were no differences in hospital admissions or health care spending.
Peter Huckfeldt, PhD
Findings of a recent study demonstrate reductions in health care use and spending associated with an intensive lifestyle intervention for type 2 diabetes diminishes as participants age.
Such findings suggested intensive lifestyle interventions may need to be sustained to reduce long-term health care spending.
Peter Huckfeldt, PhD, Division of Health Policy and Management, University of Minnesota School of Public Health, and a team of investigators estimated the association of effective intensive lifestyle intervention for weight loss with long-term health care use and Medicare spending. They used data from the Look AHEAD randomized clinical trial which randomized participants with type 2 diabetes to either an intensive lifestyle intervention or control group of diabetes support and education. The study demonstrated improved diabetes management and reduced health care costs during the intervention.
The investigators noted the most intensive portion of the intervention and the greatest weight loss happened during the first year of the study when participants had weekly sessions with counselors, dieticians, exercise specialists, and behavioral health staff. The control group had 3 educational sessions per year in the first 4 years, then annually.
Huckfeldt and the team examined the associations of the intervention with measures of health care use, medical care spending, prescription drug spending, and Medicare eligibility owing to disability or end-stage renal disease. To measure health care use, the team looked at whether participants had any hospital admission or emergency department visit and the number of hospitalizations and emergency department visits. For annual medical care spending, they included Medicare Part A and Part B. Annual prescription drug spending was measured using total drug costs in Medicare Part D.
There were no statistically significant differences in baseline characteristics between the linked intensive lifestyle intervention and control group participants. The team found similar associations of the intervention with weight and HbA1c. The intervention group continued to have lower weight than the control group (adjusted difference: -1.9% [95% CI, -2.6 to -1.2] of initial body weight; P <.001).
Among both groups, there was a similar percentage of person-years for any hospitalization (188 person-years [15.8%] vs 174 person-years [15.3%]; adjusted difference: 0.1 [95% CI, -3.2 to 3.3] percentage points; P =.96) and any emergency department visit (285 person-years [23.9%] vs 234 person-years [20.6%]; adjusted difference: 3.5 [95% CI, -.3 to 7.2] percentage points; P =.07). There was also no difference in the annual number of hospital admissions or the annual number of emergency department visits.
The team found no significant difference in Part A spending (adjusted difference: $488 [95% CI, -$715 to $1691]; P =.43) but found higher Part B spending for the intervention group (adjusted difference: $513 [95% CI, $70 to $955]; P =.02). Intervention participants had lower mean Part D prescription drug costs compared with the control group ($5046 vs $5849; adjusted difference: −$803 [95% CI, -$1522 to -$83]; P =.03) and lower mean Part D out-of-pocket spending ($1353 vs $1536; adjusted difference: -$196 [95% CI, -$383 to -$8]; P =.04).
Despite significant reductions in weight and HbA1c in the intervention group compared with the control group, there were no postintervention differences in hospital admissions or emergency department use, Medicare Part A spending, or eligibility for Medicare owing to enrollment in Social Security Disability Insurance or end-stage renal disease.
The results suggested intensive lifestyle interventions may need to be sustained for reductions in health care costs to persist.
The study, “Associations of Intensive Lifestyle Intervention in Type 2 Diabetes With Health Care Use, Spending, and Disability,” was published online in JAMA Network Open.