Lifestyle Interventions to Prevent Type 2 Diabetes: A Systematic Review of Economic Evaluation Studies

Table 1

General features of selected studies.

Study	Country	Population	Intervention	Variables of interest	Comparison	Time horizon	Analytical approach	Study design
For diabetes prevention
Herman et al. [16], 2012	USA	≥25 y.o. IGT/IFG, BMI ≥ 24; (≥22 for Asians)	DPP lifestyle modification	Diabetes cases prevented, QALYs	Metformin, placebo	10 years	Trial-based study	CU
Herman et al. [17], 2013	USA	≥25 y.o. IGT/IFG, BMI ≥ 24; (≥22 for Asian)	Lifestyle modification and metformin	Diabetes cases prevented, QALYs	Placebo	10 years	Trial-based study	CU
van Wier et al. [18], 2013	Netherlands	Adults aged 30–50 y at risk of T2D	Lifestyle intervention implemented in primary care	Risk of T2D, risk of CVD, and CVD mortality in the following 10 years	Provision of health brochures	10 years (duration 2 years)	Trial-based study	CU/CE
Sagarra et al. [19], 2014	Spain	Adults aged 45–75 y with IFG/IGT	Lifestyle intervention (individual or group intensive intervention)	Diabetes cases prevented, QALYs	Routine care	4 years	Trial-based study	CU/CE
Kolu et al. [20], 2013	Finland	≥40 years; BMI ≥ 25 or IGT, history of macrosomia, and type 2 or type 1 diabetes in first- or second-degree relatives	Lifestyle modification	Health perception, birth weight, and quality of life	Routine care	37 weeks	Trial-based study	CU/CE
Oostdam et al. [21], 2012	Germany	Overweight pregnant women and at least one of the following: history of macrosomia, GDM, or first grade relative with diabetes or obese	Exercise program (FitFor2)	Maternal fasting blood glucose, QALYs, infant birth weight, and insulin sensitivity	Routine care	32 weeks	Trial-based study	CU
Liu et al. [22], 2013	China	Age ≥25 y, IGT	One-time screening for IGT/T2D with positive case receiving (i) lifestyle intervention/diet; (ii) lifestyle intervention/exercise; (iii) both diet and exercise; (iv) one-time screening alone.	Remaining survival years and QALYs	Control	40 years	Model-based study (decision tree and Markov)	CU
Png et al. [23], 2014	Singapore	Subjects with prediabetes; (IFG/IGT)	Lifestyle modification	QALYs	Metformin/; placebo	3 years	Model-based study (decision tree)	CU
Bertram et al. [24], 2010	Australia	Age ≥45 y and high BMI, family history of T2D, or people from indigenous, and women with GDM	Diet and/or exercise,	Diabetes cases prevented, DALYs Averted	Acarbose, metformin, and orlistat	Lifetime	Model-based study (Markov)	CE
Mortaz et al. [25], 2012	Canada	Age ≥40 y and first-degree relative with T2D, high risk population groups (aboriginals, Hispanics, Asians, or Africans), and history of IGT/IFG, GDM, hypertension, dyslipidemia, overweight, abdominal obesity, and polycystic ovary	Screening followed by lifestyle intervention	QALYs	No screening	10 years/; lifetime	Model-based study (Markov)	CU
Johansson et al. [26], 2009	Sweden	Age 30–56 y and at risk of chronic disease without known diabetes	Lifestyle intervention	QALYs	Routine care	10 years	Model-based study (Markov)	CU
Neumann et al. [27], 2011	Germany	Subjects at high risk of developing T2D	Lifestyle intervention	QALYs	Routine care	Lifetime	Model-based study (Markov)	CU
Palmer and Tucker [28], 2012	Australia	Mean age 50.6 y with IGT/IFG, BMI ≥ 34	Intensive lifestyle intervention, Metformin	QALYs	Control	Lifetime	Model-based study (Markov)	CU
Smith et al. [29], 2010	United States	BMI ≥ 25 and the 4 components of MetS as defined by NCEP/ATP III	Lifestyle intervention	QALYs	Routine care	3 years	Model-based study (Markov)	CU
For obesity control
Tsai et al. [30], 2013	USA	BMI 30–50, plus abdominal obesity plus at least one of the 4 other MetS criteria	Brief lifestyle counselling	QALYs and kilograms lost per year	Routine care	2 years	Trial-based study	CU/CE
Cobiac et al. [31], 2010	Australia	Age ≥ 40 y and BMI ≥ 27	“Lighten up to Healthy Lifestyle” and “Weight Watchers”	Weight lost/DALYs averted	Routine care	12 months	Model-based study (Markov)	CE
Miners et al. [32], 2012	United Kingdom	Age ≥ 50 y and BMI ≥ 30	E- learning devices to promote healthy diet and physical activity	Weight lost/QALYs gained	Routine care	Lifetime	Model-based study (e-learning economic evaluation model)	CU
Forster et al. [33], 2011	Australia	Age ≥ 40 y and BMI ≥ 25	The Dietary Approach to Stop Hypertension (DASH) and low fat diet intervention	Weight lost/DALYs Averted	Routine care	100 years	Model-based study (Markov)	CE
Lewis et al. [34], 2014	UK	Adult subjects with BMI ≥ 30	Lighter Life total (a very low calorie diet total dietary replacement) weight reduction program and group support appropriate for obese people	Weight lost, QALYs gained	(A) With BMI ≥ 30 group: (1) no treatment, (2) lifestyle intervention, (3) weight watchers, (4) slimming world, and (5) lighter life total movement only; (B) With BMI ≥ 40 group: (1) no treatment, (2) gastric banding, (3) gastric bypass, and (4) lighter life total movement only	10 years	Not specified	CU
Anokye et al. [35], 2011	United Kingdom	Age 40–60 y, sedentary lifestyle	Exercise Referral scheme in physical activity	QALYs	Routine care	Lifetime	Model-based study (decision tree)	CU

BMI: body mass index; CE: cost-effectiveness; CU: cost-utility; CVD: cardiovascular disease; DPP: diabetes prevention program; GDM: gestational diabetes mellitus; IGT/IFG: impaired glucose tolerance/impaired fasting glucose; T2D: type 2 diabetes.