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U.S. Diabetes Prevention Program Might Avert 885,000 Cases

By Serena Gordon
HealthDay Reporter

THURSDAY, Jan. 12 (HealthDay News) -- A national community-based diabetes prevention program in the United States could prevent or delay 885,000 cases of type 2 diabetes over 25 years, a new federal government study says.

Overall, the program would save $29.8 billion in medical costs. But, the program itself would require a $24 billion investment. Still, the researchers said, it would only take about 14 years to recoup the money spent on the program.

"The take-home message is that implementing screening and community-based lifestyle interventions can improve health and reduce health care costs over the long term. This is an efficient use of health care resources," said Xiaohui Zhuo, a health economist in the division of diabetes translation at the U.S. Centers for Disease Control and Prevention).

Findings from Zhuo's study are published in the January issue of Health Affairs, a thematic issue of the journal looking at diabetes prevention programs.

Almost 26 million Americans have type 2 diabetes, according to the CDC. The exact cause of the disease is unknown, but lifestyle factors such as being overweight or not exercising are strongly associated with the development of type 2 diabetes. People diagnosed with prediabetes can often prevent the development of type 2 diabetes by losing some weight and increasing their physical activity. The American Diabetes Association recommends at least 150 minutes of moderate aerobic activity each week.

According to the new study, everyone in the country between 65 and 84 would receive a letter offering laboratory screening for diabetes. The researchers assumed that younger people would be screened at their physicians' offices.

Zhuo's hypothetical lifestyle program is a community-based intervention based on the "Promoting a Lifestyle of Activity and Nutrition for Working to Alter the Risk of Diabetes" study. The program would include 16 intensive core sessions offered over five months to help people lose weight and to adopt other healthy lifestyle habits. The researchers estimated a weight loss of about nine pounds.

The first sessions would be followed by six monthly sessions to help reinforce and sustain the new lifestyle changes. During the second year, people would be offered eight maintenance sessions.

During the first- and second-year sessions, the training would be offered by trained lifestyle coaches. Next, follow-up sessions would be conducted by a health care provider once or twice a year, according to the study.

Realizing that not everyone would maintain a weight loss or a new exercise regimen, the authors assumed that there would be a 40 percent risk reduction in diabetes for the first two years for people between 18 and 64. They also assumed that after the first two years, there would be a decrease in the risk reduction of about 10 percent per year.

Zhuo and colleagues also assumed that older people might be more likely to sustain healthy changes and figured a 50 percent reduction in diabetes risk for the first two years and a 15 percent decline in risk reduction for each subsequent year in people between 65 and 84 years old.

The cost of this intervention would be about $300 per person for the first year, $150 for the second and about $50 a year thereafter, according to the report. The authors estimated it would take about 14 years to recoup this investment. But, over 25 years, it would save nearly $6 billion in health care costs.

Zhuo said the biggest barrier to implementing such a program would be funding. But, he said, policies offering incentives to private insurers for providing diabetes-prevention reimbursement might help get more insurers to consider making the investment.

Some insurers are onboard with the concept of prevention programs. In another article in the same issue of the journal, Deneen Vojta, chief clinical officer for the UnitedHealth Diabetes Prevention and Control Alliance, reviewed different strategies that may help stem the rising tide of type 2 diabetes. These ideas include encouraging lifestyle changes, developing partnerships with pharmacists, nurses and health coaches, and implementing new programs for Medicare and Medicaid to help patients make lifestyle changes.

"This is a problem the whole world is facing. It's the concept of changing the paradigm and shifting the focus from treatment to prevention," said Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center in New York City.

"Prevention is cheaper and investments in health do save in the long term. But, who's going to sponsor it?" he asked.

Zonszein said it's also critically important that any diabetes program and education be tailored to the specific population. That means what works in a wealthy suburban setting probably won't be helpful in a poorer inner-city area and vice versa. "Diet and exercise programs have to be individually tailored," he said.

More information

See if you're at risk for type 2 diabetes by visiting the American Diabetes Association.

SOURCES: Xiaohui Zhuo, Ph.D., health economist, division of diabetes translation, U.S. Centers for Disease Control and Prevention, Atlanta; Joel Zonszein, M.D., director, clinical diabetes center, Montefiore Medical Center, New York City; January 2012, Health Affairs

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