Lifestyle Changes and Cardiovascular Outcomes for Patients with Diabetes

It seems very logical that getting people to adopt healthy lifestyles–eat a good diet, get enough exercise, manage stress, avoid high-risk activities like smoking, drug use or too much alcohol intake–will both lower health spending and improve ultimate health outcomes.  One expensive chronic condition is diabetes, which also can have an impact on the cardiovascular health of patients.  Research reported in the New England Journal of Medicine suggests that an intensive lifestyle intervention for these patients did not improve cardiovascular outcomes.   (NEJM Article)   Analyzing over 5000 overweight patients with diabetes and following them for a very long period, a program of diet control and exercise  was successful in producing greater weight loss, better glycemic control, better all-around fitness and better control of most cardiovascular risk factors, but was unsuccessful in reducing death from cardiovascular causes, nonfatal heart attacks, nonfatal stroke or hospitalizations for chest pain.  The intervention patients also received significant counseling and support from providers.  The loss of weight and the other improvements in health undoubtedly are important and almost certainly improve the quality of life for these patients.  And the researchers did not compute economic outcomes, but you would suspect health utilization and spending was lower for the intervention group, perhaps enough to outweigh the cost of the intervention.  It is unclear why rates of cardiovascular events were not different; perhaps more weight loss is needed or perhaps the control group had enough weight loss and health improvement to reduce their risks.  But these interventions should not be abandoned just  because they don’t appear to change some outcomes; they have other benefits that are worth pursuing.