Diabetes Self-Management Blog

It is often noted that diabetes is epidemic in the United States — affecting approximately 26 million people, or more than 8% of the population, according to the American Diabetes Association. Yet another figure supplied by that organization may be even more striking: An estimated 79 million Americans have prediabetes. To avoid a massive increase in the number of Americans with Type 2 diabetes, there will need to be serious prevention efforts aimed at those with prediabetes. What shape should those efforts take?

A recent study sheds some light on the topic. Presented last month at the 71st Scientific Sessions of the American Diabetes Association, results from the Diabetes Prevention Program — which enrolled over 3,000 adults at high risk for developing Type 2 diabetes — suggest that trying to prevent diabetes with either drugs or lifestyle intervention has both benefits and drawbacks. According to a HealthDay article on the study, participants were randomly assigned either to take metformin, to take a placebo (inactive pill), or to participate in a lifestyle intervention program. This phase lasted for three years and resulted in reduced rates of diabetes in the lifestyle and metformin groups, compared with the placebo group — by 58% and 31%, respectively.

The researchers wanted, however, to measure the long-term effects of these interventions, so they followed participants for an additional 7 years without keeping track of continued behaviors or treatments. Ten years after the start of the study, having been assigned to lifestyle intervention was found to reduce the rate of diabetes by 34%, and having been assigned to metformin was found to reduce the rate by 18%, compared with the placebo group. Furthermore, these reduced diabetes rates resulted in an average savings of $2,600 in medical costs for each person in the lifestyle group and $1,500 for each in the metformin group. However, administering the lifestyle treatment during the three-year study period was also significantly more expensive than dispensing metformin during that time. Therefore, over ten years, metformin resulted in a net savings of $30 per person, while lifestyle intervention resulted in a net cost of $1,700 per person.

According to one of the study’s authors, these results mean that metformin should be “broadly appl[ied] without question” for prediabetes, since it both saves money and improves health. Even at the cost it rang up during the study, however, lifestyle intervention was “cost-effective” as a treatment because of its superior medical outcome. And there is reason to believe that effective lifestyle intervention treatments could be offered at a lower cost, using group treatments rather than one-on-one sessions, as the study used. An example of such a program is the YMCA’s Diabetes Prevention Program, available at many centers across the country (details vary based on location; read about the New York City program here).

But overall, how should insurance companies — or public insurance programs — decide what kinds of preventive treatments to cover? Should they focus only on overall cost savings, or also take improved health into account — even if a treatment costs more money in the end than it saves? Who should determine whether a treatment is likely to be cost-effective? Should this be a general or patient-by-patient determination? If a treatment is not found to be cost-effective — that is, it is expensive and not likely to provide a large medical benefit — who should pay for it? Leave a comment below!


  1. It’s outrageous that insurers or any health leader should demand that “lifestyle interventions” must pay for themselves. Drugs and surgeries don’t have to be revenue-neutral. They just have to show some modest clinical benefit, and they’re approved without a second thought.

    But behavioral or social programs are supposed to pay for themselves. Why is that? I wrote about this in chapter 4 of my book Diabetes: Sugar-Coated Crisis. It’s all about who gets paid, not what’s best for the patients. We’ll pay drug companies or elite surgeons, but not health educators.

    However,it is certainly true that group programs are considerably cheaper and more effective than one-on-one programs. You don’t even need health professionals to lead them, trained amateurs can do just as well. A community-based group health approach like this is both clinically effective and cost-effective.

    Posted by David Spero RN |

Post a Comment

Note: All comments are moderated and there may be a delay in the publication of your comment. Please be on-topic and appropriate. Do not disclose personal information. Be respectful of other posters. Only post information that is correct and true to your knowledge. When referencing information that is not based on personal experience, please provide links to your sources. All commenters are considered to be nonmedical professionals unless explicitly stated otherwise. Promotion of your own or someone else's business or competing site is not allowed: Sharing links to sites that are relevant to the topic at hand is permitted, but advertising is not. Once submitted, comments cannot be modified or deleted by their authors. Comments that don't follow the guidelines above may be deleted without warning. Such actions are at the sole discretion of DiabetesSelfManagement.com. Comments are moderated Monday through Friday by the editors of DiabetesSelfManagement.com. The moderators are employees of Madavor Media, LLC., and do not report any conflicts of interest. A privacy policy setting forth our policies regarding the collection, use, and disclosure of certain information relating to you and your use of this Web site can be found here. For more information, please read our Terms and Conditions.

Sandwich Trouble (10/15/14)
Soda Surrender? (10/08/14)
Marketing to Kids (10/01/14)
Obamacare, Round 2 (09/22/14)



Disclaimer of Medical Advice: You understand that the blog posts and comments to such blog posts (whether posted by us, our agents or bloggers, or by users) do not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs. The opinions and other information contained in the blog posts and comments do not reflect the opinions or positions of the Site Proprietor.

Blood Glucose Self-Monitoring — Part 3: Smart Monitoring

10 Keys to Long-Term Weight Loss

Take Your Best Shot: Stay Up to Date on Vaccines

Complete table of contents
Subscription questions