Unexpected Bonus Benefit With Lifestyle Intervention in Type 2 Diabetes

An intensive lifestyle intervention (ILI) designed to prevent the progression and complications of type 2 diabetes was associated with boosted employment rates, according to an ancillary study of the Look AHEAD (Action for Health in Diabetes) randomized trial.

Among a total of 3,091 adults, employment rates increased 2.9% (95% CI 0.3-5.5, P=0.03) for those in an ILI program compared with controls, who received group-based diabetes education, reported Peter Huckfeldt, PhD, of the University of Minnesota School of Public Health in Minneapolis, and colleagues.

“These effects are commensurate to the ILI’s effects on weight (8% reduction in the first year of the trial), physical fitness (10% increase in metabolic equivalents in the first 4 years of the trial), and mobility loss (48% reduction in the first 4 years of the trial),” they wrote in JAMA Internal Medicine.

“A previous cost-effectiveness analysis of Look AHEAD (focused on health utility and health care spending) found mixed evidence for whether the benefits of the ILI justified the costs,” they explained. “Our findings imply that the ILI had benefits in terms of employment and disability benefit receipt that are not captured by typical cost-effectiveness frameworks, although overall effects on earnings and disability payments were statistically insignificant.”

“The key takeaway from the study for clinicians is that better diabetes management may influence patients’ well being more broadly, in this case of our study by extending patients’ ability to work,” Huckfeldt told MedPage Today.

“We did not know what to expect from the study because, to our knowledge, no one has studied the effects of successful intensive lifestyle intervention in type 2 diabetes on labor market outcomes — successful in the sense that it lowered weight and improved diabetes control,” he said.

The link between the ILI and employment appeared to be driven by people who did not have a college degree. For these individuals, there was a 5.2% higher employment rate for those who participated in the ILI. This group also saw significantly lower disability benefit receipt (-2.2%) and lower disability benefit payments ($-365).

While employment rates were higher for those who participated in the ILI, overall earnings didn’t differ between the groups. The percentage of people who received disability benefits was also not significantly different between the groups, the researchers noted.

None of these outcomes — employment, earnings, or disability receipt and payments — were different between the groups for people with at least a college degree.

Involving a combination of lifestyle counselors, dietitians, exercise specialists, and behavioral therapists, the ILI program consisted of one-on-one weekly sessions for the initial 6 months. After that point, participants had monthly sessions, which continued through the fourth year, which then turned into annual sessions. The goal was to achieve and maintain at least a 7% weight loss; a 5% weight loss is the threshold considered clinically significant. The control group had three group sessions in the first 4 years followed by annual sessions.

This analysis was conducted as an ancillary study to the Look AHEAD randomized clinical trial, which included people with type 2 diabetes and overweight or obesity. Huckfeldt’s group linked the trial data with Social Security Administration records to measure outcomes in the labor market outcomes during and after the intervention period.

A total of 1,559 adults participated in the ILI and 1,532 were in the control group. The average age was 58, baseline BMI was 36, and the average duration of diabetes was 6.5 years. Around 43% were college graduates.

“Labor market productivity should be considered when evaluating interventions to control chronic diseases,” the researchers suggested.

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