Economic impact of moderate weight loss in patients with Type 2 diabetes: the Fremantle Diabetes Study.

摘要

AIM: To assess the change in the cost of diabetes medication attributable to moderate weight loss in patients with Type 2 diabetes. METHODS: Longitudinal data collected annually from 590 patients participating in the observational, community-based Fremantle Diabetes Study were examined to determine whether moderate weight loss (>/= 5% of initial body weight) was independently associated with diabetes medication cost during 4 years' follow-up. RESULTS: Overall, the weight of the cohort decreased significantly during 4.3 +/- 0.4 years' follow-up by 1.3 +/- 6.2 kg (-1.4 +/- 7.9% baseline body weight; trend P < 0.001). Moderate weight loss was achieved by 31%. HbA(1c) improved significantly in the group with moderate weight loss compared with the group without moderate weight loss [-4 +/- 16 mmol/mol (-0.3 +/- 1.5%) vs. 0 +/- 17 mmol/mol (0.0 +/- 1.5%), P = 0.015]. Mean (bias-corrected 95% confidence intervals) diabetes medication costs were Dollars A820 (Dollars A744-907) during follow-up. As the cost distribution was highly right-skewed and contained zeros, it was square root ( radical) transformed before multiple linear regression analysis. The most parsimonious model of baseline associates of radical(diabetes medication cost) included glycaemic control, diabetes treatment, diabetes duration, BMI, systolic blood pressure, serum HDL cholesterol (negative), taking lipid-lowering medication and age (negative) (adjusted R(2) = 73.6%). After adjusting for these variables, radical(diabetes medication cost) was negatively associated with moderate weight loss (P = 0.026). After entering average values for the cohort into the model, the cost of diabetes medications between baseline and fourth review for an average patient with no weight loss was Dollars A752 compared with Dollars A652 for a patient who attained moderate weight loss, a saving of Dollars A100 (-13.3%). DISCUSSION: These data highlight the economic and clinical benefits of moderate weight loss in Type 2 diabetes.