Cost-Effectiveness of Screening for Pre-Diabetes Among Overweight and Obese U.S. Adults

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States
Diabetes care (Impact Factor: 8.42). 12/2007; 30(11):2874-9. DOI: 10.2337/dc07-0885
Source: PubMed


To estimate the cost-effectiveness of screening overweight and obese individuals for pre-diabetes and then modifying their lifestyle based on the Diabetes Prevention Program (DPP).
A Markov simulation model was used to estimate disease progression, costs, and quality of life. Cost-effectiveness was evaluated from a health care system perspective. We considered two screening/treatment strategies for pre-diabetes. Strategy 1 included screening overweight subjects and giving them the lifestyle intervention included in the DPP if they were diagnosed with both impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). Strategy 2 included screening followed by lifestyle intervention for subjects diagnosed with either IGT or IFG or both. Each strategy was compared with a program of no screening.
Screening for pre-diabetes and treating those identified as having both IGT and IFG with the DPP lifestyle intervention had a cost-effectiveness ratio of $8,181 per quality-adjusted life-year (QALY) relative to no screening. If treatment was also provided to subjects with only IGT or only IFG (strategy 2), the cost-effectiveness ratio increased to $9,511 per QALY. Changes in screening-related parameters had small effects on the cost-effectiveness ratios; the results were more sensitive to changes in intervention-related parameters.
Screening for pre-diabetes in the overweight and obese U.S. population followed by the DPP lifestyle intervention has a relatively attractive cost-effectiveness ratio.

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Available from: Ping Zhang, Oct 07, 2015
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    • "Screening for IFG/IGT is highly recommended, and the most efficient sequence of testing would be an FPG followed by a 2-hour plasma glucose after a 75 g glucose load to demonstrate the presence of combined IFG/IGT.7 Screening for prediabetes in the overweight and obese populations has been demonstrated to be cost-effective.50 More novel approaches may include the preDx® (Tethys Bioscience Inc, Emeryville, CA, USA) test, which represents a collection of variables (glycated hemoglobin [HbA1c], adiponectin, C-reactive protein, ferritin, glucose, interleukin-2 receptor A, and insulin) that have better predictive value than any single variable, which is clinically available, and a metabolomics analysis, which has suggested that glycine, lysophosphatidylcholine, and acetylcarnitine levels in plasma predict progression to diabetes.51–53 "
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    ABSTRACT: Clinical trials have demonstrated that it is possible to prevent diabetes through lifestyle modification, pharmacological intervention, and surgery. This review aims to summarize the effectiveness of these various therapeutic interventions in reducing the risk of progression of prediabetes to diabetes, and address the challenges to implement a diabetes prevention program at a community level. Strategies focusing on intensive lifestyle changes are not only efficient but cost-effective and/or cost-saving. Indeed, lifestyle intervention in people at high risk for type 2 diabetes mellitus (T2DM) has been successful in achieving sustained behavioral changes and a reduction in diabetes incidence even after the counseling is stopped. Although prediabetes is associated with health and economic burdens, it has not been adequately addressed by interventions or regulatory agencies in terms of prevention or disease management. Lifestyle intervention strategies to prevent T2DM should be distinct for different populations around the globe and should emphasize sex, age, ethnicity, and cultural and geographical considerations to be feasible and to promote better compliance. The translation of diabetes prevention research at a population level, especially finding the most effective methods of preventing T2DM in various societies and cultural settings remains challenging, but must be accomplished to stop this worldwide epidemic.
    Therapeutics and Clinical Risk Management 03/2014; 10(1):173-188. DOI:10.2147/TCRM.S39564 · 1.47 Impact Factor
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    • "Preliminary data from this pilot program suggest that diabetes-coaching programs in a community pharmacy setting can effectively aid patients to establish and sustain healthy behavioral habits. This is promising as lifestyle behaviors are considered major contributors to chronic conditions such as type 2 diabetes [13] [14]. This pilot was successful in increasing participant confidence in their ability to achieve their individual goals and enhanced their outlook on the importance of achieving their self-set goals. "
    Open Journal of Preventive Medicine 01/2014; 04(06):499-503. DOI:10.4236/ojpm.2014.46058
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    • "Cost-effectiveness analysis can ensure that limited resources are allocated as efficiently as possible, so that decision makers can take informed decisions based on the benefits outweighing the costs [19]. Although active screening for T2D combined with subsequent lifestyle intervention is cost-effective [20] compared to the “wait and see” or “do nothing” approach that currently prevails, no study has emphasized the cost-effectiveness of culturally adapted lifestyle interventions for high-risk immigrants from Iraq. "
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    ABSTRACT: Studies have shown that lifestyle interventions are effective in preventing or delaying the onset of type 2 diabetes in high-risk patients. However, research on the effectiveness of lifestyle interventions in high-risk immigrant populations with different cultural and socioeconomic backgrounds is scarce. The aim was to design a culturally adapted lifestyle intervention for an immigrant population and to evaluate its effectiveness and cost-effectiveness.Methods/designIn this randomized controlled trial, 308 participants (born in Iraq, living in Malmo, Sweden and at high risk of type 2 diabetes) will be allocated to either a culturally adapted intervention or a control group. The intervention will consist of 10 group counseling sessions focusing on diet, physical activity and behavioral change over 6 months, and the offer of exercise sessions. Cultural adaptation includes gender-specific exercise sessions, and counseling by a health coach community member. The control group will receive the information about healthy lifestyle habits provided by the primary health care center. The primary outcome is change in fasting glucose level. Secondary outcomes are changes in body mass index, insulin sensitivity, physical activity, food habits and health-related quality of life. Measurements will be taken at baseline, after 3 and 6 months. Data will be analyzed by the intention-to-treat approach. The cost-effectiveness during the trial period and over the longer term will be assessed by simulation modeling from patient, health care and societal perspectives. This study will provide a basis to measure the effectiveness of a lifestyle intervention designed for immigrants from the Middle East in terms of improvement in glucose metabolism, and will also assess its cost-effectiveness. Results from this trial may help health care providers and policy makers to adapt and implement lifestyle interventions suitable for this population group that can be conducted in the community.Trial RegistrationNumber at NCT01420198.
    Trials 09/2013; 14(1):279. DOI:10.1186/1745-6215-14-279 · 1.73 Impact Factor
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