Diet, Metformin Cut Medical Cost for Prediabetes Patients

June 28, 2011 (San Diego) -- People with prediabetes can save thousands of dollars in medical costs by taking the diabetes drug metformin or making lifestyle changes, a new study shows.

Treatment with the inexpensive drug metformin, which lowers blood sugar levels, reduced costs by $1,700 over a decade, the researchers say. Intensive lifestyle changes, such as participating in tailored weight loss and exercise programs, saved $2,600 per person.

The study also showed that people who ate right and exercised had the highest scores on quality-of-life questionnaires that measure physical and mental functioning.

The cost savings are in line with other standard prevention strategies such as childhood immunizations and beta-blocker treatment in people who have had a heart attack, says William Herman, MD, professor of internal medicine at the University of Michigan, Ann Arbor.

The interventions should be offered to all people at high risk of developing diabetes, he tells WebMD.  About 79 million Americans have prediabetes and are at high risk, according to the CDC. 

Herman presented the study here at the annual meeting of the American Diabetes Association.

Cost-Savings Analysis

The cost-savings analysis comes from seven years of follow-up to the three-year study called he Diabetes Prevention Program (DPP). The study was halted early when both metformin and lifestyle changes far outperformed placebo.

The DPP showed that 10 years of treatment with metformin lowered the risk of developing diabetes by 18%, while lifestyle changes reduced the chance by 34%.

The economic analysis showed that lifestyle strategies were more expensive to implement, costing about $4,500 per person over 10 years. Metformin cost about $2,000 over a decade.

The increased cost of lifestyle programs was offset by the $2,600 savings in medical care, which included money spent on doctor and hospital visits as well as on drugs, Herman says.

When dollars spent were weighed against money saved, metformin saved $30 per person over 10 years and the lifestyle intervention cost $1,500.

While no price tag can be placed on improved physical and mental well-being, the researchers also weighed in the finding that lifestyle changes were associated with better quality-of-life scores than metformin, Herman says. 

"Compared to doing nothing, the metformin intervention is cost-saving for diabetes prevention, and the intensive lifestyleintervention, though not saving dollars over 10 years, is extremely cost-effective," he says.

New Approach for Diabetes Prevention

The new analysis "is important because as soon as DPP was published, people said, 'This is great but we don't have the resources,'" Herman says.

Only one in 10 common prevention strategies -- prenatal care and flu shots, for example -- actually saves money, he says.

The cost savings in the new study included lower costs for doctor and hospital visits as well as for drugs.

"I'm really stunned by these findings," says James Meigs, MD, of Massachusetts General Hospital in Boston. "They could revolutionize the way we approach diabetes prevention."

Most people prefer making exercise and dietary changes to taking a drug, says Meigs, who was not involved with the research.

In the study, the focus of the lifestyle intervention program was on losing and maintaining a 7% loss in body weight and 30 minutes a day of brisk walking, five times a week, or its equivalent, according to Herman.