title: Economic impact of moderate weight loss in patients with Type 2 diabetes: the Fremantle Diabetes Study.
abstract: OBJECTIVE
  To assess the change in the cost of diabetes medication attributable to moderate weight loss in patients with Type 2 diabetes.
  
  
  METHODS
  Longitudinal data collected annually from 590 patients participating in the observational, community-based Fremantle Diabetes Study were examined to determine whether moderate weight loss (≥ 5% of initial body weight) was independently associated with diabetes medication cost during 4 years' follow-up.
  
  
  RESULTS
  Overall, the weight of the cohort decreased significantly during 4.3 ± 0.4 years' follow-up by 1.3 ± 6.2 kg (-1.4 ± 7.9% baseline body weight; trend P < 0.001). Moderate weight loss was achieved by 31%. HbA(1c) improved significantly in the group with moderate weight loss compared with the group without moderate weight loss [-4 ± 16 mmol/mol (-0.3 ± 1.5%) vs. 0 ± 17 mmol/mol (0.0 ± 1.5%), P = 0.015]. Mean (bias-corrected 95% confidence intervals) diabetes medication costs were $A820 ($A744-907) during follow-up. As the cost distribution was highly right-skewed and contained zeros, it was square root (√) transformed before multiple linear regression analysis. The most parsimonious model of baseline associates of √(diabetes medication cost) included glycaemic control, diabetes treatment, diabetes duration, BMI, systolic blood pressure, serum HDL cholesterol (negative), taking lipid-lowering medication and age (negative) (adjusted R(2) = 73.6%). After adjusting for these variables, √(diabetes medication cost) was negatively associated with moderate weight loss (P = 0.026). After entering average values for the cohort into the model, the cost of diabetes medications between baseline and fourth review for an average patient with no weight loss was $A752 compared with $A652 for a patient who attained moderate weight loss, a saving of $A100 (-13.3%).
  
  
  CONCLUSIONS
  These data highlight the economic and clinical benefits of moderate weight loss in Type 2 diabetes.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia. wdavis@meddent.uwa.edu.au
authors.forename: W A
authors.initials: WA
authors.lastname: Davis
authors.forename: D G
authors.initials: DG
authors.lastname: Bruce
authors.forename: T M E
authors.initials: TM
authors.lastname: Davis
mesh_terms: D001786:Blood Glucose / Q000187:drug effects*; D001835:Body Weight / Q000187:drug effects*; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000188:drug therapy / Q000191:economics*; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents