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Health & Medicine for Senior Citizens

Lifestyle Changes Reduced Type 2 Diabetes Risk 58%; Highly Effective for Seniors

Over 10 years, the lifestyle and metformin interventions resulted in health benefits and reduced the costs of inpatient and outpatient care and prescriptions…

March 22, 2012 - Programs to prevent or delay type 2 diabetes in high-risk adults would result in fewer people developing diabetes and lower health care costs over time, researchers say. A program involving lifestyle changes, which was particularly effective for people age 60 and older, reduced the rate of diabetes in high risk adults by 58 percent.

Prevention programs that apply interventions tested in the landmark Diabetes Prevention Program (DPP) clinical trial would also improve quality of life for people who would otherwise develop type 2 diabetes.

The analysis of costs and outcomes in the DPP and its follow-up study is published in the April 2012 issue of Diabetes Care and online March 22 at http://diabetes.org/diabetescare. The study was funded by the National Institutes of Health.

The DPP showed that lifestyle changes (reduced fat and calories in the diet and increased physical activity) leading to modest weight loss reduced the rate of type 2 diabetes in high-risk adults by 58 percent, compared with placebo. Metformin reduced diabetes by 31 percent.

These initial results were published in 2002. As researchers monitored participants for seven more years in the DPP Outcomes Study (DPPOS), they continued to see lower rates of diabetes in the lifestyle and metformin groups compared with placebo (www.nih.gov/news/health/oct2009/niddk-29.htm).

Lifestyle changes were especially beneficial for people age 60 and older.

 

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The economic analysis of the DPP/DPPOS found that metformin treatment led to a small savings in health care costs over 10 years, compared with placebo. (At present, metformin, an oral drug used to treat type 2 diabetes, is not approved by the Food and Drug Administration for diabetes prevention.)

The lifestyle intervention as applied in the study was cost-effective, or justified by the benefits of diabetes prevention and improved health over 10 years, compared with placebo.

"Over 10 years, the lifestyle and metformin interventions resulted in health benefits and reduced the costs of inpatient and outpatient care and prescriptions, compared with placebo. From the perspective of the health care payer, these approaches make economic sense," said the study's lead author William H. Herman, M.D., M.P.H., a co-investigator of the DPP Research Group and director of the Michigan Center for Diabetes Translational Research, Ann Arbor.

The DPP enrolled 3,234 overweight or obese adults with blood sugar levels higher than normal but below the threshold for diabetes diagnosis. Participants were randomly assigned to a lifestyle intervention aimed at a 7 percent weight loss and 150 minutes per week of moderate intensity activity, metformin treatment, or placebo pills. The groups taking metformin or placebo pills also received standard lifestyle recommendations.

"We don't often see new therapies that are more effective and at the same time less costly than usual care, as was the case with metformin in the DPP. And while the lifestyle intervention was cost-effective, we would see greater savings if the program were implemented in communities," said Griffin P. Rodgers, M.D., director of the NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

"This has already been demonstrated in other NIDDK-funded projects, including one in YMCAs, where a lifestyle-change program cost $300 per person per year in a group setting, compared to about $1,400 for one-on-one attention in the DPP."

In the DPP, direct costs over 10 years per participant for the lifestyle and metformin interventions were higher than for placebo ($4,601 lifestyle, $2,300 metformin, and $769 placebo). The higher cost of the lifestyle intervention was due largely to the individualized training those participants received in a 16-session curriculum during the DPP and in group sessions during the DPPOS to reinforce behavior changes.

However, the costs of medical care received outside the DPP, for example hospitalizations and outpatient visits, were higher for the placebo group ($27,468) compared with lifestyle ($24,563) or metformin ($25,616).

Over 10 years, the combined costs of the interventions and medical care outside the study were lowest for metformin ($27,915) and higher for lifestyle ($29,164) compared with placebo ($28,236). Throughout the study, quality of life as measured by mobility, level of pain, emotional outlook and other indicators was consistently better for the lifestyle group.

"The DPP demonstrated that the diabetes epidemic, with more than 1.9 million new cases per year in the United States, can be curtailed. We now show that these interventions also represent good value for the money," said David M. Nathan, M.D., study chair and professor of medicine at Harvard Medical School, Boston.

In the United States, nearly 26 million people have diabetes, and up to 95 percent of them have type 2 diabetes. About 7 million people have type 2 diabetes but do not know it.

In addition, about 79 million adults have prediabetes, with high blood sugar levels that are not yet in the diabetic range. Prediabetes substantially raises the risk for developing type 2 diabetes. Learn more about diabetes at http://diabetes.niddk.nih.gov and at www.YourDiabetesInfo.org.

The studies were funded by the NIDDK; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute on Aging; National Eye Institute; National Heart, Lung, and Blood Institute; National Institute on Minority Health and Health Disparities; National Center for Research Resources; and the Office of Research on Women's Health all part of NIH. Additional funding came from the Indian Health Service, the Centers for Disease Control and Prevention, the Department of Veterans Affairs, and the American Diabetes Association. Bristol-Myers Squibb and Parke-Davis provided funding and material support for the DPP. Lipha (Merck-Sanyo) provided medication, and LifeScan Inc. donated materials.

The NIDDK, a part of the NIH, conducts and supports research on diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe and disabling conditions affecting Americans. For more information about the NIDDK and its programs, see www.niddk.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.


About Type 2 Diabetes and Older People

By NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Diabetes means your blood glucose, or blood sugar, is too high. With Type 2 diabetes, the more common type, your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy. Without insulin, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your heart, eyes, kidneys, nerves, gums and teeth.

You have a higher risk of type 2 diabetes if you are older, obese, have a family history of diabetes, or do not exercise.

The symptoms of type 2 diabetes appear slowly. Some people do not notice symptoms at all. The symptoms can include

   ● Being very thirsty

   ● Urinating often

   ● Feeling very hungry or tired

   ● Losing weight without trying

   ● Having sores that heal slowly

   ● Having blurry eyesight

A blood test can show if you have diabetes. Many people can manage their diabetes through healthy eating, physical activity, and blood glucose testing. Some people also need to take diabetes medicines.

Should I be tested for diabetes?

Anyone 45 years old or older should consider getting tested for diabetes. If you are 45 or older and overweight-see the BMI chart -getting tested is strongly recommended. If you are younger than 45, overweight, and have one or more of the risk factors, you should consider getting tested. Ask your doctor for a fasting blood glucose test or an oral glucose tolerance test. Your doctor will tell you if you have normal blood glucose, prediabetes, or diabetes.

   ● Among U.S. residents ages 65 years and older, 10.9 million, or 26.9 percent, had diabetes in 2010.

   ● Diabetes affects 25.8 million people of all ages - 8.3 percent of the U.S. population
       ● DIAGNOSED - 18.8 million people
       ● UNDIAGNOSED - 7.0 million people

   ● About 215,000 people younger than 20 years had diabetes—type 1 or type 2—in the United States in 2010.

   ● About 1.9 million people ages 20 years or older were newly diagnosed with diabetes in 2010 in the United States.

   ● In 2005–2008, based on fasting glucose or hemoglobin A1C (A1C) levels, 35 percent of U.S. adults ages 20 years or older had prediabetes - 50 percent of adults ages 65 years or older. Applying this percentage to the entire U.S. population in 2010 yields an estimated 79 million American adults ages 20 years or older with prediabetes.

   ● Diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputations, and new cases of blindness among adults in the United States.

   ● Diabetes is a major cause of heart disease and stroke.

   ● Diabetes is the seventh leading cause of death in the United States.

 

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