Effect of the Look AHEAD Study Intervention on Medication Use and Related Cost to Treat Cardiovascular Disease Risk Factors in Individuals With Type 2 Diabetes

Abstract

OBJECTIVETo examine the effect of a lifestyle intervention to produce weight loss and increased physical fitness on use and cost of medications to treat cardiovascular disease (CVD) risk factors in people with type 2 diabetes.RESEARCH DESIGN AND METHODSLook AHEAD is a multicenter randomized controlled trial of 5,145 overweight or obese individuals with type 2 diabetes, aged 45–76 years. An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition. Medications prescribed to treat diabetes, hypertension, and hyperlipidemia were compared at baseline and 1 year. Medication costs were conservatively estimated using prices from a national online pharmacy.RESULTSParticipants randomized to an ILI had significantly greater improvements in CVD risk parameters and reduced medication use and cost compared with those assigned to DSE. At 1 year, average number of medications prescribed to treat CVD risk factors was 3.1 ± 1.8 for the ILI group and 3.6 ± 1.8 for the DSE group (P < 0.0001), with estimated total monthly medication costs of $143 and $173, respectively (P < 0.0001). DSE participants meeting optimal care goals at 1 year were taking an average of 3.8 ± 1.6 medications at an estimated cost of $194/month. ILI participants at optimal care required fewer medications (3.2 ± 1.7) at lower cost ($154/month) (P < 0.001).CONCLUSIONSAt 1 year, ILI significantly improved CVD risk factors, while at the same time reduced medication use and cost. Continued intervention and follow-up will determine whether these changes are maintained and reduce cardiovascular risk.

A Randomized, Controlled Multisite Study of Behavioral Interventions for Veterans with Mental Illness and Antipsychotic Medication-Associated Obesity

“…Weight loss interventions can reduce concomitant medication use and overall cost. [22][23][24] This study replicated and expanded our original behavioral intervention research, 25 which added to the literature with a longer 12-month intervention and focus on veterans with APD-associated obesity.…”

Treatment of diabetic vasculopathy: an overview

“…77 The one-year results of Look AHEAD demonstrate that intensive lifestyle intervention results in clinically significant weight loss in people with type 2 diabetes which is associated with improved diabetes control and cardiovascular risk factors and, at the same time, reduced medication use and cost. 78 Several further years are needed to determine whether the initial weight loss can be maintained, whether intentional weight loss has a long-term effect on risk factors, and whether the weight loss reduces cardiovascular mortality and morbidity. 78,79 Li et al reported 20-year follow-up results on incidence of type 2 diabetes and cardiovascular disease from the China Da Qing Diabetes Prevention Study 80 and found that the reduction in diabetes incidence persists in the combined intervention group, which is also supported by the findings from the Finnish Diabetes Prevention Study 81 (with seven years of follow-up).…”

“…78 Several further years are needed to determine whether the initial weight loss can be maintained, whether intentional weight loss has a long-term effect on risk factors, and whether the weight loss reduces cardiovascular mortality and morbidity. 78,79 Li et al reported 20-year follow-up results on incidence of type 2 diabetes and cardiovascular disease from the China Da Qing Diabetes Prevention Study 80 and found that the reduction in diabetes incidence persists in the combined intervention group, which is also supported by the findings from the Finnish Diabetes Prevention Study 81 (with seven years of follow-up). However, whether lifestyle intervention also leads to reduced cardiovascular disease and mortality remains unclear.…”

Self-Management Support Interventions That are Clinically Linked and Technology Enabled: Can They Successfully Prevent and Treat Diabetes?

“…2 Studies show that lifestyle and self-management support, such as physical activity and proper nutrition, play a critical role in the prevention and treatment of type 2 diabetes and in a patient's overall health. [3][4][5][6][7][8][9][10] Yet health care providers do not have the time-nor is it their job-to provide this form of ongoing and comprehensive self-management support for their patients.…”