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FOCUS ON DIABETES CARE Charles
D. Ponte, Section Advisor
Intensive lifestyle intervention improves CVD risk factors
Key point: Increased physical activity and diet and
behavior modification were more effective at reducing cardiovascu-lar
disease (CVD) risk factors and medication use in overweight patients
with type 2 diabetes compared with the current standard of general
diabetes support and education.
Finer points: Look AHEAD (Action for Health and
Diabetes), an ongoing long-term clinical trial funded by the National
Institutes of Health, is evaluating the effects of an intensive
lifestyle intervention on morbidity and mortality secondary to CVD in
persons with diabetes. In the June issue of Diabetes Care, J.
Bruce Redmon, MD, and colleagues report interim data on the effect of
the intervention on medication requirements and estimated medication
costs to treat CVD risk fac-tors. Patients were randomized to receive
usual care consisting of general diabetes support and education (n =
2,502), or an intensive lifestyle intervention consisting of increased
physical activity and diet and behavior modification (n = 2,496). At
baseline, only 10% of patients were achieving optimal care goals (target
glycosylated hemoglobin [<7%], blood pressure [130/80 mm Hg], and LDL
cholesterol [<100 mg/dL] values) despite taking an average of 3.3
prescription medications per month. After 1 year, more than 20% of
patients receiving the intensive lifestyle intervention achieved optimal
care goals and had significantly lower medication use (3.2 ± 1.7
prescribed medications per month) than those receiving usual care (3.8
± 1.6; P < 0.001). For those achieving optical care
goals, medication costs per month were significantly less for the
intervention group (n = 517, mean cost $154) compared with usual care (n
= 359, mean cost $194; P < 0.001). Overall, 40% of patients
in the intervention group were taking two or fewer medications per month
compared with 28% of those receiving usual care. Medication costs
decreased by about 10% in the intervention group but increased by about
10% in the usual care group. According to the authors, follow-up and
continued intervention will determine whether the effects of the
intervention are maintained.
What you need to know: Previous interim results from
the Look AHEAD trial showed that the intervention improves quality of
life, physical fitness, and weight loss more than usual care. Redmon et
al found that after only 1 year, an inten-sive lifestyle intervention
for overweight patients with diabetes was more effective than usual care
in improving CVD risk factors and reducing medication use and costs.
Compared with usual care, patients in the intervention group had more
frequent and intensive counseling sessions, were given meal replacements
to assist with weight loss, and received orlistat
(Alli—GlaxoSmithKline; Xenical—Roche) to promote weight
loss. The costs of the additional services received by the intensive
lifestyle intervention group were not addressed in this report. A
cost-benefit analysis will be performed with the completion of the Look
AHEAD trial.
What your patients need to know: Tell patients with
diabetes that an intensive lifestyle intervention lowers medication
costs and reduces the risk of heart disease and stroke better than the
diabetes education and counseling that most patients currently receive.
Encourage patients to discuss behavior modification with their
prescriber to improve diet, increase ex-ercise, and promote weight
loss.
Source:
Related resource on www.pharmacist.com:
Posted by Alex Egervary (aegervary@aphanet.org)
June 22, 2010, 5:00 pm
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