title: Lifestyle interventions for diabetes mellitus type 2 prevention.
abstract: OBJECTIVE
  Transferring the results from clinical trials on type 2 diabetes prevention is the objective of the Diabetes in Europe-Prevention using Lifestyle, Physical Activity and Nutritional intervention (DE-PLAN) project in Catalonia, whose cost-effectiveness analysis is now presented.
  
  
  METHODS
  A prospective cohort study was performed in primary care involving individuals without diagnosed diabetes aged 45-75 years (n=2054) screened using the questionnaire Finnish Diabetes Risk Score (FINDRISC) and a subsequent oral glucose tolerance test. Where feasible, high-risk individuals who were identified (n=552) were allocated sequentially to standard care (n=219), a group-based (n=230) or an individual-level (n=103) intensive (structured programme of six hours using specific teaching techniques) lifestyle intervention (n=333). The primary outcome was the development of diabetes (WHO). We evaluated the cost of resources used with comparison of standard care and the intervention groups in terms of effectiveness and quality of life (15D questionnaire).
  
  
  RESULTS
  After 4.2-year median follow-up, the cumulative incidences were 18.3% (14.3-22.9%) in the intensive intervention group and 28.8% (22.9-35.3%) in the standard care group (36.5% relative-risk-reduction). The corresponding 4-year HR was 0.64 (0.47-0.87; P<.004). The incremental cost induced by intensive intervention compared with the standard was 106€ per participant in the individual level and 10€ in the group-based intervention representing 746€ and 108€ per averted case of diabetes, respectively. The estimated incremental cost-utility ratio was 3243€ per quality-adjusted life-years gained.
  
  
  CONCLUSIONS
  The intensive lifestyle intervention delayed the development of diabetes and was efficient in economic analysis.
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Grupo de Investigación en Diabetes Reus-Tarragona, Institut Català de la Salut, Reus, Tarragona, España.
authors.forename: R
authors.initials: R
authors.lastname: Sagarra
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Grupo de Investigación en Diabetes Reus-Tarragona, Institut Català de la Salut, Reus, Tarragona, España. Electronic address: costaber@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Costa
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Grupo de Investigación en Diabetes Reus-Tarragona, Institut Català de la Salut, Reus, Tarragona, España.
authors.forename: J J
authors.initials: JJ
authors.lastname: Cabré
authors.affiliation: Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Tarragona, España; Agència d'Informació, Avaluació i Qualitat en Salut (AIAQS), Generalitat de Catalunya, Barcelona, España.
authors.forename: O
authors.initials: O
authors.lastname: Solà-Morales
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Grupo de Investigación en Diabetes Reus-Tarragona, Institut Català de la Salut, Reus, Tarragona, España.
authors.forename: F
authors.initials: F
authors.lastname: Barrio
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D040242:Risk Reduction Behavior; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Calidad de vida; Cost-effectiveness; Cost-utility; Coste-efectividad; Coste-utilidad; Diabetes; Efectividad; Effectiveness; Glucemia basal alterada; Impaired fasting glucose; Impaired glucose tolerance; Incidence; Incidencia; Intolerancia a la glucosa; Prediabetes; Prevención; Prevention; Quality of life