The authors performed a literature search to identify randomized controlled trials that addressed lifestyle issues for patients with type 2 diabetes. Recent trials (2003 to 2008) that included at least 150 subjects and had a minimum follow-up of 12 months were eligible for inclusion.
Given diabetics’ high risk for cardiovascular complications, the authors add, optimal management of lifestyle issues is increasingly acknowledged as being an essential part of diabetes treatment.
The researchers used a computer-based simulation model to project long-term health benefits and cost-effectiveness in the Dutch diabetic population. They applied a lifelong time horizon.
Seven trials with between 147 and 5145 subjects were included in the analysis. All interventions improved cardiovascular risk factors at 1 year follow-up. The interventions, which were projected to reduce cardiovascular complications over a lifetime, included losing weight, decreasing systolic blood pressure and glycosylated hemoglobin, smoking cessation, physical activity, and increasing consumption of fruit and vegetables.
Life expectancy was increased with each intervention by 0.02 to 0.34 years, and discounted quality adjusted life years (QALYs) were increased by 0.1 to 0.14 per participant.
Despite prevented costs for complications, all interventions were projected to increase health care costs over a lifetime, because of increased survival.
Health gains were generally achieved at reasonable costs (< €50,000/QALY). It was found that self-management education and physical activity counseling achieved the most promising results with > 0.10 QALYs gained per person and a very high probability of being cost-effective.
Lifestyle modifications are likely to improve long-term health, at reasonable costs, in patients with diabetes. Because the potential benefits of successful lifestyle interventions are huge,we should be investing much more in gathering information on long-term maintenance of these health benefits.
Source : Diabetes Care 2009;32:1453-1458.