Objectives To demonstrate that lifestyle modifications will reduce the cost of routine medications in individuals with type 2 diabetes (T2D), through a mechanism involving glycaemic control.
Design A within-trial cost-medication analysis with a 1-year time horizon.
Setting Controlled environment within the spa resort of Chatel-Guyon, France.
Participants Twenty-nine participants (aged 50–70 years) with T2D.
Interventions A 1-year follow-up intervention, beginning with a 3-week residential programme combining high exercise volume (15–20 hours/week), restrictive diet (−500 kcal/day) and education. Participants continued their routine medication, independently managed by their general practitioner.
Main outcome measures Number of medications, number of pills, cost of medications and health-related outcomes.
Results Twenty-six participants completed the 1-year intervention. At 1 year, 14 patients out of 26 (54%) stopped/decreased their medications whereas only 5 (19%) increased or introduced new drugs (χ2=6.3, p=0.02). The number of pills per day decreased by 1.3±0.3 at 12 months (p<0.001). The annual cost of medications for T2D were lower at 1 year (€135.1±43.9) versus baseline (€212.6±35.8) (p=0.03). The regression coefficients on costs of routine medication were 0.507 (95% CI 0.056 to 0.959, p=0.027) for HbA1c and 0.156 (95% CI −0.010 to 0.322, p=0.06) for blood glucose levels. Diabetics patients with HbA1c >6.5% in the highest (last) quartile doubled their routine medication costs (66% vs 33%, p=0.037).
Conclusions Individuals with T2D reduced routine medication costs following a long-term lifestyle intervention that started with a 3-week residential programme. Combining high exercise volume, restrictive diet and education effectively supported the health of T2D. The main factor explaining reduced medication costs was better glycaemic control, independent of weight changes. Despite limitations precluding generalisability, cost-effective results of reduced medication should contribute to the evidence base required to promote lifestyle interventions for individuals with T2D.
Trial registration number NCT00917917; Post-results.
- MEDICAL EDUCATION & TRAINING
- NUTRITION & DIETETICS
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
Contributors FD has participated as a PhD student and main investigator. FD, BL, DC, PO, GW and AV contributed to the conception of the protocol. FD recruited all patients. MD and FD performed maximal exercise testing. FD performed aliquoting of blood samples. RC was responsible for the residential programme. BL supervised daily diet and managed physical activity. BP and FD conducted the statistical analysis. CL and FD drafted the manuscript. GN and BP revised the manuscript. All authors critically reviewed the scientific content and approved the final version to be published. CL and FD take full responsibility for the work as a whole.
Funding The study was supported by the Fondation Coeur et Artères 59200 Loos, France, grant number is FCA N°07T2. http://www.fondacoeur.com.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The study was approved by university hospital ethics committees from St Etienne, France.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.