In the United States almost 26 million individuals are affected by diabetes and it is estimated that over the next 10 years 40 million more individuals in the country could develop diabetes. Furthermore, an additional 100 million people could develop an insidious prediabetic condition that frequently leads to diabetes.

Often being overweight or obese triggers the condition. According to increasing scientific evidence, fitness programs and weight loss can prevent or delay type 2 diabetes from developing. However, do lifestyle interventions save money in the long term and do they lead to maintained weight loss?

Several aspects of this complicated issue as well as the hurdles that need to be tackled in order to control diabetes are explored in the January issue of Health Affairs. One report in this month’s issue by Deneen Vojta and colleagues at UnitedHealth Group suggests that by the year 2021 the increase in new cases could add an estimated $512 billion to the country’s yearly health care costs.

The New York State Health Foundation, UnitedHealth Foundation and Novo Nordisk supported this issue of Health Affairs.

In this month’s issue, four reports reveal scientific evidence indicating that lifestyle interventions can effectively prevent or inhibit diabetes:

  1. According to an examination by Xiaohui Zhuo and Ann Albright at the Centers for Disease Control and Prevention and their team, it would require an efficient use of resources to establish a national program of community-level interventions for the prevention of type 2 diabetes. Using a computer simulation model, the researchers estimate the costs and benefits of such a nationwide program. According to their estimates, such an intervention could prevent of delay approximately 885,000 individuals developing type 2 diabetes within 25 years, saving the U.S. health care system an estimated $5.7 billion.
  2. Several human trials demonstrate that individuals who are seriously overweight or obese who lose between 5% to 7% of body weight can prevent progression of prediabetes to diabetes, say Deneen Vojta and colleagues at UnitedHealth Group. Although, programs designed to help individuals lose weight have not been executed on a large scale.

    They conclude that in order to prevent the situation from worsening, the country should enroll high-risk individuals in proven models that encourage maintaining lifelong fitness habits and weight loss. Recently community-based interventions designed to help individuals at risk of developing diabetes follow a healthier eating habits and regular physical activity were launched by UnitedHealth Group in collaboration with the YMCA of the USA as well as the Centers for Disease Control and Prevention. In addition, UnitedHealth Group established retail pharmacy-based interventions across communities to help those with diabetes choose healthier behaviors.

  3. In order to determine if cheaper interventions based on the Diabetes Prevention Program encourage individuals to lose weight in real-life settings, Mohammed K. Ali and his team at Emory University carried out a systematic review and meta-analysis of 28 investigations. They discovered that the average participant lost approximately 4% of baseline body weight (an amount that can offer protection against diabetes) after 1 year of enrollment in lifestyle intervention programs.

    The team found that regardless of whether the program relied on lower-cost lay staff trained to deliver healthy eating and fitness advice, or higher-salaried professionals – the weight loss was the same. According to the researchers the most successful programs were those that were structured and motivate higher session attendance.

  4. Kenneth Thorpe at Emory University explains that failings in the current health care system frequently result in fragmented and costly care for chronic conditions, including type 2 diabetes. In order to develop a national, coordinated public health treatment and prevention program for diabetes that could be used to tackle obesity and other chronic conditions, policy makers should build on several provisions in the Affordable Care Act, according to Thorpe.

Two papers highlight the present restrictions in lifestyle intervention programs for the prevention or treatment of type 2 diabetes. The researchers stress that it would be wise to focus on improved treatment and management of the disease that can deliver established and real benefits, such as a lower risk of complications:

  1. Richard Kahn at the University of North Carolina explains that even though investigations have demonstrated that losing weight prevents or delays diabetes, the majority of individuals gain the weight back after the trial stops. According to Kahn, unless researchers have a better understanding about the complicated factors underlying the biology of energy intake and expenditure, prevention efforts will not be effective.

    Kahn explains that population wide approaches are required in order to reduce overall energy consumption as we live in an environment where food is abundant and cheap. Kahn concludes that medical management of diabetes could easily be improved, thus significantly reducing complications resulting from the condition.

  2. Bradley Gray at the American Board of Internal Medicine and his team examined whether interventions controlled by physicians, such as prescribing medicine for hypertension, or interventions that are more controlled by patients, such as a diabetic friendly diet or weight loss, made the most difference. In order to find out, the team used a well-known computer model to simulate a 30 year human trial.

    They discovered that if all patients diagnosed in the U.S. with diabetes met aggressive targets for reducing LDL cholesterol, blood sugar levels and blood pressure, they would benefit more than following dietary recommendations, although diet remained a vital factor. According to the investigators, physicians have a considerable opportunity to enhance the health of patients with diabetes by collaborating with them to reach these targets.

Written by Grace Rattue