Improved Type 2 Diabetes Patient Outcomes and Projected Cost Savings Following Supervised Exercise Training

Abstract

Physical activity has long been a primary intervention to manage type 2 diabetes. PURPOSE: Because type 2 diabetes outpatients do not always follow the recommendation by health care professionals to exercise, this project followed 8 outpatients referred to the Diabetes Education Centre (DEC) by their primary care physician who agreed to participate in a kinesiologist-directed exercise training program offered at the Hospital for 11 months. METHODS: 2 males and 6 females (60.9 ± 10.4 years; 93.7 ± 25.9 kg; 162.3 ± 10.1 cm; means ± SD) completed testing before, after 3 months and after 11 months of training. They exercised in a supervised setting (combination of up to 25 minutes of aerobic, up to 25 minutes of resistance and 10 minutes of flexibility exercises) twice a week for ∼11 months. RESULTS: Compared to baseline measures, early (i.e. 3 months) significant findings included improvements in aerobic capacity assessed using a submaximal step test (114%), grip strength (14%), push-ups (670%), curl-ups (234%), as well as functional capacity assessed using the sit-to-stand tests (56, 15 and 14%). Long term effects (i.e. 11 months) also included significant decreases in systolic blood pressure from 131 to 122 mmHg and decreases in sum of 2 and sum of 5 skin folds by 16 and 12% respectively. There were no significant changes in blood work including lipid profile however hemoglobin A1C exhibited a clinically relevant decrease from 7.1 % to 6.1 % after 11 months of intervention in this group. Collectively, these improvements in patient outcomes have been associated with improvements in quality of life and cost savings. Based on the observed changes in hemoglobin A1C and blood pressure alone and using the data of Palmer et al. (Current Medical Research and Opinion, 2004; 20, S53-S58.), we can conservatively project a lifetime cost savings of ∼$11000 US per patient. The cost of providing the kinesiologist-directed exercise training will offset part of these savings; however, indirect costs of physical inactivity would also be reduced by a program of this type. Future research should identify the long-term adherence parameters required to maintain the observed patient outcomes and further delineate the cost-savings analysis. CONCLUSION: The results of this project suggest the addition of a kinesiologist to the multidisciplinary health care team in a DEC will have significant long term health benefits for type 2 diabetes outpatients and can contribute to reducing health care costs in this population. Supported by the Nova Scotia Health Research Foundation, Eastern Kings Memorial Health Foundation and Thera-Band ®.