U.S. Department of Health and Human Services

Interventions to Prevent Type 2 Diabetes Provide Good Return on Investment

New research has shown that using either of two interventions to prevent or delay type 2 diabetes in people at high risk for the disease would be a very cost effective way to improve their health and quality of life. The landmark Diabetes Prevention Program (DPP) clinical study demonstrated that an intensive lifestyle intervention designed to achieve modest weight loss through a combination of diet and exercise lowered type 2 diabetes rates by 58 percent, and that the generic diabetes medication metformin reduced diabetes rates by 31 percent, relative to placebo. Subsequently, researchers with the follow-up DPP Outcomes Study (DPPOS) showed that the health benefits of both DPP interventions persisted for at least 10 years. In the new report, DPP researchers examined per person costs of the interventions during the trial and follow up, total direct medical costs outside the DPP/DPPOS, and measures of quality of life over 10 years. They found that the lifestyle intervention was cost-effective—that is, its modest net cost was well justified by the benefits of diabetes prevention, overall improvements in health, and the reduction in other health care costs. The new research also found that, although health benefits from metformin treatment were more limited than those conferred by the lifestyle intervention, the use of this inexpensive drug in the DPP population yielded a modest cost savings. The greater reduction in health care costs from the more expensive lifestyle intervention was nearly enough to offset the cost of the intervention, so that the lifestyle intervention was highly cost effective and nearly cost neutral. Previous research showed that metformin was most effective among DPP participants who were less than 60 years of age when the trial began, and among those with a history of gestational diabetes. 

Throughout the study, quality of life as measured by mobility, level of pain, emotional outlook, and other indicators was consistently best in the lifestyle group, compared to metformin or placebo. These findings are particularly encouraging in light of other NIDDK-supported research demonstrating the feasibility of substantially reducing the cost of the lifestyle intervention by delivering it to groups in community-based settings such as YMCAs. It is hoped that this approach will yield both health care savings and better health for many people, if widely implemented. 
Diabetes Prevention Program Research Group. The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/ DPPOS. Diabetes Care 35: 723-730, 2012.