Source/Disclosures
Disclosures: Lean reports he received grants from Diabetes UK and nonfinancial support from Cambridge Weight during the conduct of the study, and he has given unpaid advice about management of medically complicated patients to Counterweight Ltd. Please see the study for all other authors’ relevant financial disclosures.
October 08, 2020
2 min read
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Weight loss, diabetes remission lead to cost savings over lifetime

Source/Disclosures
Disclosures: Lean reports he received grants from Diabetes UK and nonfinancial support from Cambridge Weight during the conduct of the study, and he has given unpaid advice about management of medically complicated patients to Counterweight Ltd. Please see the study for all other authors’ relevant financial disclosures.
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Participants in the Diabetes Remission Clinical Trial’s counter-weight plus intervention had a higher diabetes remission rate and were projected to have lower lifetime health care costs compared with controls, according to study data.

“It is most unusual to be able to provide a new medical treatment for a major chronic disease which is both health improving and cost-saving,” Michael E. J. Lean, MD, FRCP, FRCPS, a clinical senior research fellow and honorary consultant in human nutrition in the School of Medicine, Dentistry and Nursing at the University of Glasgow, U.K., and colleagues wrote in a study published in Diabetologia. “The Diabetes Remission Clinical Trial (DiRECT) study has shown that durable remissions of type 2 diabetes to a nondiabetic state can be achieved through an integrated weight-management program. ... The present analysis indicates that the intervention is likely to generate quality-adjusted life-year gains and be not only cost-effective, but also cost-saving after 5 to 6 years.”

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Researchers conducted an analysis of intervention and routine costs with all participants in the counterweight-plus intervention in DiRECT. Intervention costs included training, monitoring appointments with providers, program materials and sachets of low-energy formula diet. Details on medications and routine medical care were gathered from general practitioner records. Researchers also estimated lifetime cost-effectiveness by predicting time to relapse among participants who had been in remission for 2 years. Cost-analysis figures from 149 DiRECT participants were compared with a matching control group that received standard of care treatment. All cost figures were listed in 2018 British pounds.

Individuals in the DiRECT intervention group had higher mean 2-year total health care costs during their participation in the program when compared with the control group (mean difference, 616 British pounds; 95% CI, –45 to 1,269). Mean intervention costs amounted to 1,411 British pounds, with the formula diet and practice visits making up most of the costs (mean costs, 1,364 British pounds; 95% CI, 1,260-1,464). DiRECT participants had an estimated mean savings of about 796 British pounds from lower medication use and fewer routine health visits during the 2-year period when compared with the control group. Although there was negligible nonintervention cost savings between the two groups in year 1, the second year of the study yielded a mean savings in nonintervention costs of 521 British pounds (95% CI, 12-1,085).

The DiRECT intervention group had more individuals reach diabetes remission over 2 years (35.6% vs. 3.4%) and added more QALYs (11.27 vs. 11.22) when compared with the control group. The study’s model predicted the intervention group would save 1,337 British pounds (95% CI, 674-2,081) over a lifetime compared with standard of care and overall cost savings would be reached after 5 to 6 years.

“Relapse into diabetes, driven by weight regain, incurs costs from relapse management and from resumption of progressive costs for diabetes and its complications,” the researchers wrote. “Though relapse had a bearing on outcomes in our study, even relatively rapid relapse did not alter the conclusion that the low-energy diet intervention was capable of producing long-term health gains without adding long-term costs. The counterweight-plus intervention may, therefore, be expected to be transferable to other diabetes care settings in a similarly cost-effective manner.”