Effect of the Look AHEAD Study Intervention on Medication Use and Related Cost to Treat Cardiovascular Disease Risk Factors in individuals With Type 2 Diabetes

Objective: To examine the effect of a lifestyle intervention to produce weight loss and increased physical fitness on use and cost of medications to treat cardiovascular disease (CVD) risk factors in people with type 2 diabetes. Research Design and Method: Look AHEAD is a multi-center randomized controlled trial of 5,145 overweight or obese individuals with type 2 diabetes, aged 45-76 years. An intensive lifestyle intervention involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity (ILI) was compared with a diabetes support and education (DSE) condition. Medications prescribed to treat diabetes, hypertension and hyperlipidemia were compared at baseline and 1-year. Medication costs were conservatively estimated using prices from a national on-line pharmacy. Results: Participants randomized to ILI had significantly greater improvements in CVD risk parameters and reduced medication use and cost compared to DSE. At 1-year, average number of medications prescribed to treat CVD risk factors was 3.1±1.8 for ILI and 3.6±1.8 for DSE (P<0.0001) with estimated total monthly medication costs of $143 and $173, respectively (P<0.0001). DSE participants meeting optimal care goals at 1-year were taking an average of 3.8±1.6 medications at an estimated cost of $194/month. ILI participants at optimal care required fewer medications (3.2±1.7) at lower cost ($154/month) (P<0.001). Conclusions: At 1 year, ILI significantly improved CVD risk factors while at the same time reducing medication use and cost. Continued intervention and follow-up will determine whether these changes are maintained and reduce CV risk.