U.S. diabetes prevention program might avert 885,000 cases
A national community-based diabetes prevention program in the
United States could prevent or delay 885,000 cases of type 2
diabetes over 25 years, a new federal government study says.
Overall, the program would save $29.8 billion in medical costs.
But, the program itself would require a $24 billion investment.
Still, the researchers said, it would only take about 14 years to
recoup the money spent on the program.
"The take-home message is that implementing screening and
community-based lifestyle interventions can improve health and
reduce health care costs over the long term. This is an efficient
use of health care resources," said Xiaohui Zhuo, a health
economist in the division of diabetes translation at the U.S.
Centers for Disease Control and Prevention).
Findings from Zhuo's study are published in the January issue of
Health Affairs, a thematic issue of the journal looking at diabetes
prevention programs.
Almost 26 million Americans have type 2 diabetes, according to the
CDC. The exact cause of the disease is unknown, but lifestyle
factors such as being overweight or not exercising are strongly
associated with the development of type 2 diabetes. People
diagnosed with prediabetes can often prevent the development of
type 2 diabetes by losing some weight and increasing their physical
activity. The American Diabetes Association recommends at least 150
minutes of moderate aerobic activity each week.
According to the new study, everyone in the country between 65 and
84 would receive a letter offering laboratory screening for
diabetes. The researchers assumed that younger people would be
screened at their physicians' offices.
Zhuo's hypothetical lifestyle program is a community-based
intervention based on the "Promoting a Lifestyle of Activity and
Nutrition for Working to Alter the Risk of Diabetes" study. The
program would include 16 intensive core sessions offered over five
months to help people lose weight and to adopt other healthy
lifestyle habits. The researchers estimated a weight loss of about
nine pounds.
The first sessions would be followed by six monthly sessions to
help reinforce and sustain the new lifestyle changes. During the
second year, people would be offered eight maintenance
sessions.
During the first- and second-year sessions, the training would be
offered by trained lifestyle coaches. Next, follow-up sessions
would be conducted by a health care provider once or twice a year,
according to the study.
Realizing that not everyone would maintain a weight loss or a new
exercise regimen, the authors assumed that there would be a 40
percent risk reduction in diabetes for the first two years for
people between 18 and 64. They also assumed that after the first
two years, there would be a decrease in the risk reduction of about
10 percent per year.
Zhuo and colleagues also assumed that older people might be more
likely to sustain healthy changes and figured a 50 percent
reduction in diabetes risk for the first two years and a 15 percent
decline in risk reduction for each subsequent year in people
between 65 and 84 years old.
The cost of this intervention would be about $300 per person for
the first year, $150 for the second and about $50 a year
thereafter, according to the report. The authors estimated it would
take about 14 years to recoup this investment. But, over 25 years,
it would save nearly $6 billion in health care costs.
Zhuo said the biggest barrier to implementing such a program would
be funding. But, he said, policies offering incentives to private
insurers for providing diabetes-prevention reimbursement might help
get more insurers to consider making the investment.
Some insurers are onboard with the concept of prevention programs.
In another article in the same issue of the journal, Deneen Vojta,
chief clinical officer for the UnitedHealth Diabetes Prevention and
Control Alliance, reviewed different strategies that may help stem
the rising tide of type 2 diabetes. These ideas include encouraging
lifestyle changes, developing partnerships with pharmacists, nurses
and health coaches, and implementing new programs for Medicare and
Medicaid to help patients make lifestyle changes.
"This is a problem the whole world is facing. It's the concept of
changing the paradigm and shifting the focus from treatment to
prevention," said Dr. Joel Zonszein, director of the clinical
diabetes center at Montefiore Medical Center in New York
City.
"Prevention is cheaper and investments in health do save in the
long term. But, who's going to sponsor it?" he asked.
Zonszein said it's also critically important that any diabetes
program and education be tailored to the specific population. That
means what works in a wealthy suburban setting probably won't be
helpful in a poorer inner-city area and vice versa. "Diet and
exercise programs have to be individually tailored," he said.
