Adherence
An intensive lifestyle intervention (ILI) for weight loss in adults with type 2 diabetes and overweight/obesity is not cost-effective over a 9-year period compared to standard diabetes support and education (DSE), as the high cost of delivering the intervention is not offset by sufficient gains in quality-adjusted life years (QALYs).
For patients with type 2 diabetes, intensive lifestyle changes (like losing 7% of body weight) do improve health markers and may save some medical costs, but the program itself is expensive to run. Over 9 years, the health benefits (QALYs) gained are small and may not justify the high cost of intensive counseling for everyone. However, for individuals who prefer to avoid medication, lifestyle modification remains a valid, effective option for improving blood sugar and blood pressure, even if it is not 'cost-effective' from a system-wide perspective.
The ILI was not likely to be cost-effective for two main reasons. First, delivering ILI as implemented in the trial was resource intensive... Although ILI led to fewer hospitalizations, less use of medications, and lower total medical care costs, the savings in health care expenditures were not large enough to offset the costs of delivering ILI. Second, the intervention led to little or no gain in QALYs.
Why this rating
Large randomized controlled trial (Look AHEAD) with 9-year follow-up and intention-to-treat analysis, though cost-effectiveness conclusions vary by utility measure.
Source
Within-Trial Cost-Effectiveness of a Structured Lifestyle Intervention in Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Action for Health in Diabetes (Look AHEAD) Study
Ping Zhang et al. · Diabetes Care · 2020
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