BACKGROUND: A high proportion of people with diabetes in the US have overweight or obesity.
OBJECTIVE: To compare economic outcomes in patients with T2D experiencing a reduction in HbA1c with and without co-occurring weight loss.
METHODS: Adults with T2D were identified from 2015-2019 in the IQVIA Ambulatory EMR and linked claims databases. The index date was the first observed A1c value followed by 24 months health plan enrollment (months 1-12: classification period, months 13-24: 1-year outcome assessment [OA] period). In ±90 days of index date, a weight value and ≥1 pharmacy claim for an antihyperglycemic medication were required; at the end of classification period (±90 days) a weight value and an A1c reduction of ≥0.3 were required. Patients with BMI <18.5 kg/m2, any condition affecting weight (e.g., pregnancy), bariatric surgery, or weight loss ≥20% of their index value were excluded. Two cohorts were identified: weight loss cohort (weight decreased by >5% at the end of classification period) and no weight loss cohort. Unadjusted and adjusted all-cause (AC) and T2D-related costs were evaluated in the classification and 1, 2, and 3 year OA periods.
RESULTS: 4,654 patients were identified with A1c reduction (21.9% weight loss and 78.1% no weight loss cohort). Mean age and Charlson Comorbidity Index score were similar across cohorts; there were more females in the weight loss cohort (46.7%) vs. the no weight loss cohort (37.9%). Differences in mean index A1c (8.3 vs. 8.9) and BMI (36.3 vs. 34.4) were observed between cohorts. Among patients in the no weight loss cohort, annual mean AC costs were $14,262 in classification period and $14,220, $15,119, and $15,894 in years 1, 2, and 3 of OA periods, respectively. Among patients in the weight loss cohort, annual mean AC costs decreased by over 21% between classification ($16,131) and year 1 ($12,658) of the OA period and remained reduced in years 2 ($12,761) and 3 ($12,856) of the OA periods. Similar results were observed for T2D-related costs. Multivariable analyses found the weight loss cohort had lower AC and T2D-related costs in years 1, 2, and 3 of the OA period versus the no weight loss cohort (P<.0001).
CONCLUSIONS: This study showed that treated patients with T2D with A1c reduction and weight loss of >5% have lower AC and diabetes-related healthcare costs in the years following weight loss and A1c reduction compared to patients with A1c reduction and no weight loss. To reduce healthcare costs for patients with T2D, medications that target both A1c and weight reduction should be considered.
