Lifestyle intervention to prevent diabetes: intensive and cost effective.
OBJECTIVE
Type 2 diabetes is a major cause of morbidity and mortality, and despite treatment advances appears to be increasing in incidence. Since individuals at risk for the disease are usually identifiable in the prediabetic phase of impaired glucose tolerance, early intervention might prevent diabetes and hence its complications from developing. Obesity and sedentary living are powerful determinants of diabetes, and thus lifestyle change is a logical approach to prevention of this disease. Recent clinical trials have now tested the effectiveness of this intervention and form the basis for this review.


RESULTS
Three clinical trials have demonstrated that, compared with usual care, lifestyle intervention significantly reduced progression rates to diabetes in prediabetic individuals. Each trial incorporated individualization and repeated long-term contacts with facilitators, in which dietary and physical activity goal setting and behavior modification were central themes. Progression to diabetes was reduced in the Da Qing study by approximately 40%, in the Finnish Diabetes Prevention Study by 58% and in the Diabetes Prevention Program by 58%. The Diabetes Prevention Program included a cost-benefit unit that estimated the per capita costs of the lifestyle intervention to exceed that of the usual care group by Dollars 3540, which translated to a cost of Dollars 15,700 per case of diabetes prevented. Lifetime cost-utility analysis demonstrated an overall cost of Dollars 1100 per quality-adjusted life year.


CONCLUSIONS
These findings make the case for translation of research findings to healthcare systems. Although there is more to be learned about effective strategies in clinical practice, it seems clear that the intervention needs to incorporate individualization and long-term interaction with trained facilitators.
Wylie-Rosett
Judith
J
Division of Health Behavior and Nutrition, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA.
Herman
William H
WH
Goldberg
Ronald B
RB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic / Q000191:economics; D003365:Costs and Cost Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D005951:Glucose Tolerance Test; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000191:economics / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors