ALEXANDRIA, Va. — Lifestyle intervention and treatment with metformin provide safe, long-term, cost-effective means of preventing Type 2 diabetes and should be incorporated into prevention strategies for reducing the dramatic rise in incidence of Type 2 diabetes in the United States, according to two new analyses and an editorial published in the April issue of Diabetes Care.
The two reports provide further analyses and follow-up to the landmark Diabetes Prevention Program research first funded a decade ago primarily by the National Institutes of Health’s National Institute of Diabetes and Digestive and Kidney Diseases. The studies are accompanied by an editorial highlighting the American Diabetes Association’s recently revised Strategic Plan, which calls for an increased focus on translating the growing body of research on prevention into primary care and community treatment strategies.
One analysis by the Diabetes Prevention Program Research Group found that over 10 years, investing in lifestyle intervention or treatment with metformin for adults at high risk for Type 2 diabetes provided “good value for the money.” Over the first three years of the clinical trial, lifestyle interventions — losing 5% to 8% of body weight, or 10 to 16 lbs. for a 200-lb. person, plus increasing physical activity to at least 150 minutes per week — reduced the incidence of Type 2 diabetes by 58% and significantly improved quality of life. Metformin reduced diabetes by 31%. This follow-up analysis found that lifestyle intervention came at a cost-effectiveness of about $10,000 per cumulative-quality-adjusted life-year gained. Cost-effectiveness of such commonly used interventions as mammography or blood pressure generally range from $10,000 to $50,000 per QALY.
"This new analysis of costs and outcomes in the DPP and its follow-up study show both metformin and lifestyle change were very cost-effective for prevention or delay of Type 2 diabetes when analyzed from the perspective of healthcare payers," stated Griffin Rodgers, director of the NIH’s National Institute of Diabetes and Digestive and Kidney Diseases. "Metformin treatment led to a small savings in healthcare costs over 10 years. The individual training in lifestyle change, as delivered in the study, was cost-effective and could become cost saving if offered to groups in community settings."
The second analysis found that long-term treatment with metformin safely produced sustained weight loss at 10 years and prevented or delayed the onset of Type 2 diabetes.
Currently, the Centers for Disease Control and Prevention estimated that 35% of U.S. adults aged 20 years or older may have prediabetes, a condition in which blood glucose levels are higher than normal, but not yet high enough for a Type 2 diabetes diagnosis.