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