Glucose Lowering through Weight management (GLoW): An RCT of the cost-effectiveness of a diabetes education and behavioural weight management programme versus a diabetes education programme in adults with recently diagnosed type 2 diabetes

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

8A.1

Presenter:

Simon Griffin

Co-authors:

J Mueller, P Breeze, F Fusco, SJ Sharp, K Pidd, A Brennan, AJ Hill, S Morris, CA Hughes, S Bates, D Pollard, J Woolston, E Lachassseigne, M Stubbings, F Whittle, RA Jones, C Boothby, R Duschinsky, J Bostock, N Islam, AL Ahern

Author institutions:

University of Cambridge, University of Sheffield, University of Leeds, Patient and Public Involvement representative, University of Southampton, Broadstreet Health Economics & Outcomes Research Vancouver Canada

Problem

People with type 2 diabetes (T2D) who lose weight can reduce their use of medication and risk of cardiovascular disease and can even achieve remission. Structured diabetes education is standard care after diagnosis of T2D, but previous trials showed no effect on HbA1c and a small, unsustained impact on weight. We evaluated whether a tailored diabetes education and behavioural weight management programme (DEW) is more effective and cost-effective than a diabetes education (DE) programme in helping people with overweight or obesity and a recent diagnosis of T2D to lower their blood glucose, lose weight and improve other markers of cardiovascular risk.

Approach

A pragmatic, randomised, single-blind, parallel two-group trial in 159 general practices in England. Adults (≥18 years) with overweight or obesity and recently diagnosed T2D (≤ 3 years) were randomised to a tailored diabetes education and behavioural weight management programme (DEW; delivered by Weight Watchers) or to current standard care diabetes education (DE; DESMOND programme). DEW involved 2 telephone calls with a registered dietitian and 6 months access to Weight Watchers. DE was delivered in a 6-hour workshop by a registered dietitian. Participants completed assessments at 0, 6, and 12 months. The primary outcome was 12-month change from baseline HbA1c. We also assessed bodyweight, blood pressure, total cholesterol, HDL and LDL cholesterol, glucose-lowering medication, behavioural measures (physical activity, food intake), psychosocial measures (eating behaviour, diabetes-related quality of life, wellbeing) and within-trial and modelled lifetime cost-effectiveness.

Findings

We randomised 577 participants (DEW: 289, DE: 288); 398 (69%) completed 12-month follow-up. We found no evidence for an intervention effect on change in HbA1c from baseline to 12 months (difference: -0.84 [95% CI: -2.99; 1.31] mmol/mol, p=0.44) or 6 months (-1.83 [-4.05; 0.40] mmol/mol). We found an intervention effect on weight at 6 (-1.77 [-2.86; -0.67;] kg) and 12 months (-1.38 [-2.56; -0.19] kg). Participants in DEW had a higher likelihood of achieving diabetes remission than participants in DE (6 months: RR=2.10 [1.03; 4.47]; 12 months: RR=2.53 [1.30; 5.16]). DEW was cost-effective compared with DE in within-trial and lifetime analyses, in the latter generating an incremental cost-effectiveness ratio of £2,058 per quality-adjusted life year gained.

Consequences

A commercial behavioural weight management programme combined with remote dietary counselling after diagnosis of T2D did not improve HbA1c up to 12 months post-intervention, but could help more patients with overweight/obesity to achieve weight loss and remission and be more cost-effective compared with current standard NHS care.

Submitted by:

Simon Griffin

Funding acknowledgement:

This work was supported by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (RP-PG-0216-20010), the Medical Research Council (grant number MC_UU_00006/6) and the NIHR Cambridge Biomedical Research Centre (NIHR203312).