title: Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes.
abstract: OBJECTIVE
  To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial.
  
  
  METHODS
  A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes support and education (DSE). Use and costs of health-care services were recorded across an average of 10 years.
  
  
  RESULTS
  ILI led to reductions in annual hospitalizations (11%, P = 0.004), hospital days (15%, P = 0.01), and number of medications (6%, P < 0.001), resulting in cost savings for hospitalization (10%, P = 0.04) and medication (7%, P < 0.001). ILI produced a mean relative per-person 10-year cost savings of $5,280 (95% CI 3,385-7,175); however, these were not evident among individuals with a history of cardiovascular disease.
  
  
  CONCLUSIONS
  Compared with DSE over 10 years, ILI participants had fewer hospitalizations, fewer medications, and lower health-care costs.
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC mespelan@wakehealth.edu.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Espeland
authors.affiliation: Weight and Eating Disorder Program, University of Pennsylvania, Philadelphia, PA.
authors.forename: Henry A
authors.initials: HA
authors.lastname: Glick
authors.affiliation: Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Alain
authors.initials: A
authors.lastname: Bertoni
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA.
authors.forename: George A
authors.initials: GA
authors.lastname: Bray
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.affiliation: Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Curtis
authors.affiliation: Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, Providence, RI.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Egan
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Mary
authors.initials: M
authors.lastname: Evans
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: John P
authors.initials: JP
authors.lastname: Foreyt
authors.affiliation: Roybal Comprehensive Health Center, Los Angeles, CA.
authors.forename: Siran
authors.initials: S
authors.lastname: Ghazarian
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.affiliation: University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Helen P
authors.initials: HP
authors.lastname: Hazuda
authors.affiliation: Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO.
authors.forename: James O
authors.initials: JO
authors.lastname: Hill
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Don
authors.initials: D
authors.lastname: Hire
authors.affiliation: Department of Clinical Epidemiology, Joslin Diabetes Center, Boston, MA.
authors.forename: Edward S
authors.initials: ES
authors.lastname: Horton
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Van S
authors.initials: VS
authors.lastname: Hubbard
authors.affiliation: Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA.
authors.forename: John M
authors.initials: JM
authors.lastname: Jakicic
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Jeffery
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Kahn
authors.affiliation: Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM.
authors.forename: Tina
authors.initials: T
authors.lastname: Killean
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN.
authors.forename: Abbas E
authors.initials: AE
authors.lastname: Kitabchi
authors.affiliation: Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ Southwest American Indian Center, National Institute of Diabetes and Digestive and Kidney Diseases, Shiprock, NM.
authors.forename: William C
authors.initials: WC
authors.lastname: Knowler
authors.affiliation: Diabetes Unit, Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kriska
authors.affiliation: Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: Anschutz Health and Wellness Center, University of Colorado Health Sciences Center, Aurora, CO.
authors.forename: Marsha
authors.initials: M
authors.lastname: Miller
authors.affiliation: University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Maria G
authors.initials: MG
authors.lastname: Montez
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Anne
authors.initials: A
authors.lastname: Murillo
authors.affiliation: Massachusetts General Hospital, Boston, MA.
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN.
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Nyenwe
authors.affiliation: Division of and Department of Medicine, St. Luke's-Roosevelt Hospital, New York, NY.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Patricio
authors.affiliation: Roybal Comprehensive Health Center, Los Angeles, CA.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: Division of and Department of Medicine, St. Luke's-Roosevelt Hospital, New York, NY.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pi-Sunyer
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Henry
authors.initials: H
authors.lastname: Pownall
authors.affiliation: Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
authors.forename: J Bruce
authors.initials: JB
authors.lastname: Redmon
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Julia
authors.initials: J
authors.lastname: Rushing
authors.affiliation: Pennington Biomedical Research Center, Baton Rouge, LA.
authors.forename: Donna H
authors.initials: DH
authors.lastname: Ryan
authors.affiliation: Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Monika
authors.initials: M
authors.lastname: Safford
authors.affiliation: Division of Internal Medicine, University of Colorado Health Sciences Center, Aurora, CO.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Tsai
authors.affiliation: Weight and Eating Disorder Program, University of Pennsylvania, Philadelphia, PA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wadden
authors.affiliation: Weight Control and Diabetes Research Center, Brown Medical School/The Miriam Hospital, Providence, RI.
authors.forename: Rena R
authors.initials: RR
authors.lastname: Wing
authors.affiliation: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Susan Z
authors.initials: SZ
authors.lastname: Yanovski
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000191:economics* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006296:Health Services / Q000191:economics*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000191:economics*; D050177:Overweight / Q000150:complications / Q000191:economics*; D016037:Single-Blind Method