scholarly journals Within-Trial Cost-Effectiveness of a Structured Lifestyle Intervention in Adults With Overweight/Obesity and Type 2 Diabetes: Results From the Action for Health in Diabetes (Look AHEAD) Study

Diabetes Care ◽  
2020 ◽  
Vol 44 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Ping Zhang ◽  
Karen M. Atkinson ◽  
George A. Bray ◽  
Haiying Chen ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Lifestyle Intervention ◽  
Look Ahead ◽  
Trial Cost

Cost-Effectiveness of Structured Lifestyle Intervention in Overweight and Obese Adults with Type 2 Diabetes—Results from the Action for Health in Diabetes (Look AHEAD) Study

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 171-OR
Author(s):  
PING ZHANG ◽  
HAIYING CHEN ◽  
MARK ESPELAND ◽  
RENA R. WING ◽  
MARIA G. MONTEZ ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Lifestyle Intervention ◽  
Obese Adults ◽  
Look Ahead

Within trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study

2020 ◽  
Author(s):  
Ping Zhang ◽  
Karen M. Atkinson ◽  
George Bray ◽  
Haiying Chen ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Lifestyle Intervention ◽  
Health Utility Index ◽  
Health Benefit ◽  
Cost Effective ◽  
Health Utility ◽  
Health Care Expenditures ◽  
Quality Adjusted Life Year

<b>OBJECTIVE </b>To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. <p><b>RESEARCH DESIGN AND METHODS</b> Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. </p> <p><b>RESULTS </b><a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. </p> <p><b>Conclusions </b>Whether<b> </b>ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions. </p>

scholarly journals Lifestyle intervention and/or statins for the reduction of C-reactive protein in type 2 diabetes: From the look AHEAD study

Obesity ◽  
2013 ◽  
Vol 21 (5) ◽  
pp. 944-950 ◽  
Author(s):  
L. Maria Belalcazar ◽  
Steven M. Haffner ◽  
Wei Lang ◽  
Ron C. Hoogeveen ◽  
Julia Rushing ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lifestyle Intervention ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Look Ahead ◽  
The Look

scholarly journals Type 2 Diabetes Subgroups, Risk for Complications, and Differential Effects Due to an Intensive Lifestyle Intervention

2021 ◽  
Author(s):  
Michael P. Bancks ◽  
Haiying Chen ◽  
Ashok Balasubramanyam ◽  
Alain G. Bertoni ◽  
Mark A. Espeland ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Lifestyle Intervention ◽  
Age At Onset ◽  
Caloric Intake ◽  
Diabetes Diagnosis ◽  
Intensive Lifestyle Intervention ◽  
Look Ahead ◽  
Increased Risk ◽  
Differential Risk

<b>Objective:</b> We re-evaluated the Action for Health in Diabetes (Look AHEAD) intervention, incorporating diabetes subgroups, to identify whether intensive lifestyle intervention (ILI) is associated with differential risk for cardiovascular disease (CVD) by diabetes subgroup. <p><b>Research Design and Methods: </b>Look AHEAD randomized 5145 participants, aged 45-76 years, with type 2 diabetes (T2D) and overweight or obesity, to 10 years of ILI or a control condition of diabetes support and education. ILI focused on weight loss through decreased caloric intake and increased physical activity. To characterize diabetes subgroups, we applied k-means clustering to data for age of diabetes diagnosis, body mass index, waist circumference, and glycated hemoglobin. We examined whether relative intervention effects on the trial’s prespecified CVD outcomes varied among diabetes subgroups.</p> <p><b>Results:</b> We characterized four subgroups related to older age at diabetes onset (42% of sample), poor glycemic control (14%), severe obesity (24%), and younger age at onset (20%). We observed interactions (all p<0.05) between intervention and diabetes subgroup for three separate composite cardiovascular outcomes. Randomization to ILI was associated with increased risk for each cardiovascular outcome only among the poor glucose control subgroup (hazard ratios, HR >1.32). Among the three other diabetes subgroups, ILI was not associated with increased risk for CVD.</p> <p><b>Conclusion:</b> Among overweight and obese adults with T2D, a lifestyle intervention was associated with differential risk for CVD that was dependent on diabetes subgroup. Diabetes subgroups may be important to identify the patients who would achieve benefit and avoid harm from an intensive lifestyle intervention.</p>

scholarly journals Physical Function Following a Long-Term Lifestyle Intervention Among Middle Aged and Older Adults With Type 2 Diabetes: The Look AHEAD Study

2017 ◽  
Vol 73 (11) ◽  
pp. 1552-1559 ◽  
Author(s):  
Denise K Houston ◽  
Rebecca H Neiberg ◽  
Michael E Miller ◽  
James O Hill ◽  
John M Jakicic ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Physical Function ◽  
Lifestyle Intervention ◽  
Middle Aged ◽  
Look Ahead ◽  
The Look

scholarly journals A common variant in the CLDN7/ELP5 locus predicts adiponectin change with lifestyle intervention and improved fitness in obese individuals with diabetes

2015 ◽  
Vol 47 (6) ◽  
pp. 215-224 ◽  
Author(s):  
L. Maria Belalcazar ◽  
George D. Papandonatos ◽  
Jeanne M. McCaffery ◽  
Inga Peter ◽  
Nicholas M. Pajewski ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Lifestyle Intervention ◽  
Genetic Variants ◽  
Association Studies ◽  
Lifestyle Changes ◽  
Genome Wide Association Studies ◽  
Look Ahead ◽  
Genome Wide

Overweight/obese individuals with Type 2 diabetes have low adiponectin levels, which may improve with lifestyle changes. We investigated whether genetic variants associated with adiponectin levels in genome-wide association studies (GWAS) would also be related with adiponectin changes in response to an intensive lifestyle intervention (ILI), potentially through mechanisms altering the adipose microenvironment via weight loss and/or improved cardiorespiratory fitness. Look AHEAD was a randomized trial comparing the cardiovascular benefits of ILI-induced weight loss and physical activity compared with diabetes support and education among overweight/obese individuals with Type 2 diabetes. In a subsample of Look AHEAD with adiponectin data and genetic consent ( n = 1,351), we evaluated the effects of 24 genetic variants, demonstrated by GWAS to be cross-sectionally associated with adiponectin, on adiponectin change 1-yr postintervention. We explored via mediational analyses whether any differential effects by treatment arm were occurring through weight loss and/or improved fitness. A variant, rs222857, in the CLDN7 locus, potentially associated with epithelial barrier integrity and tight junction physiology, and a putative cis expression quantitative trail locus for elongator acetyltransferase complex subunit 5 ( ELP5), predicted adiponectin increases within ILI (log-adiponectin in overall sample per copy: β ± SE = 0.05 ± 0.02, P = 0.008; in non-Hispanic whites: 0.06 ± 0.02, P = 0.009). The favorable effects of rs222857 (minor allele frequency 45.5%) appeared to be mediated by mechanisms associated with improved fitness, and not weight loss. This is the first study to identify a genetic variant that modifies adiponectin response to lifestyle intervention in overweight/obese diabetic individuals.

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