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Improvements in glycemic control from combined diet and physical activity intervention drove down use of routine medications, according to new study.
A small group of patients with type 2 diabetes was able to successfully reduce their routine medication costs after following a long-term lifestyle intervention that began with a 3-week residential program, according to the results of a study published in BMJ Open.
The intervention program combined high exercise volume (15 to 20 hours per week), a restrictive diet (reduction of 500 calories per day), and education.
“Combining high exercise volume, restrictive diet and education, effectively supported the health of type 2 diabetes,” Frédéric Dutheil, MD, PhD, of the University Hospital of Clermont-Ferrand’s preventive and occupational medicine division in France, told Medical Economics. “The main factor explaining reduced medication costs was better glycemic control, independent of weight changes.”
According to Dutheil, type 2 diabetes imposes a substantial burden on the worldwide economy. This burden is related to the costs associated with the microvascular and macrovascular complications of poorly controlled diabetes, as well as indirect costs from work-related absenteeism, reduced productivity and a reduced labor force.
With this study, researchers hypothesized that lifestyle modifications would reduce the costs of routine medications for diabetes through improved glycemic control. The study included 26 participants with type 2 diabetes who completed a 3-week residential lifestyle intervention program in a controlled environment within a spa resort in France. Participants were then followed for one year and told to continue their lifestyle changes at home. Data were collected on the number of medications, number of pills, cost of medications and health-related outcomes.
“The major finding showed that a lifestyle intervention combining physical activity and diet decreased the number of medications taken by type 2 diabetes patients, which represented a reduction around 110 euros [~$120]per participant in the annual cost of medication,” Dutheil said.
During follow-up, the 29 participants were each followed by a different general practitioner. These physicians continued treatment for type 2 diabetes as usual and were not in contact with study investigators.
At one year, more than half of the study participants had stopped or decreased their diabetes medications (54%). In comparison only 19% of participants increased or introduced new medications (P=.02). After the intervention, there was a decrease of 1.3 pills per day at 1 year (P<.001).
Additionally, the annual cost of medications for type 2 diabetes was lower at one-year post-intervention (135.1 euros [~$147] vs. 212.6 euros [~$231]; P=.03). The global tendency over the one-year study showed about a 50 euro decrease in medications for high blood pressure and a 60 euro decrease in medications for type 2 diabetes.
A multivariable analysis controlling for weight, central fat, blood pressure, lipids profile, glucose metabolism, inflammation and fitness test results showed that glycemia and HbA1c were the only factors independently associated with the cost of routine medications.
The study had several limitations including the small number of participants and the lack of a control group for comparison.
“Despite limitations precluding generalizability, cost effective results of reduced medication should contribute to the evidence-base required to promote lifestyle interventions for individuals with type 2 diabetes,” Dutheil said.