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Kranz RM, Kettler C, Koeder C, Husain S, Anand C, Schoch N, Englert H. Health Economic Evaluation of a Controlled Lifestyle Intervention: The Healthy Lifestyle Community Program (Cohort 2; HLCP-2). Nutrients 2023; 15:5045. [PMID: 38140304 PMCID: PMC10745766 DOI: 10.3390/nu15245045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Non-communicable diseases (NCD) are associated with high costs for healthcare systems. We evaluated changes in total costs, comprising direct and indirect costs, due to a 24-month non-randomized, controlled lifestyle intervention trial with six measurement time points aiming to improve the risk profile for NCDs. Overall, 187 individuals from the general population aged ≥18 years were assigned to either the intervention group (IG; n = 112), receiving a 10-week intensive lifestyle intervention focusing on a healthy, plant-based diet; physical activity; stress management; and community support, followed by a 22-month follow-up phase including monthly seminars, or a control group (CG; n = 75) without intervention. The complete data sets of 118 participants (IG: n = 79; CG: n = 39) were analyzed. At baseline, total costs per person amounted to 67.80 ± 69.17 EUR in the IG and 48.73 ± 54.41 EUR in the CG per week. The reduction in total costs was significantly greater in the IG compared to the CG after 10 weeks (p = 0.012) and 6 months (p = 0.004), whereas direct costs differed significantly after 10 weeks (p = 0.017), 6 months (p = 0.041) and 12 months (p = 0.012) between the groups. The HLCP-2 was able to reduce health-related economic costs, primarily due to the reduction in direct costs.
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Affiliation(s)
- Ragna-Marie Kranz
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
- Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, 33098 Paderborn, Germany
| | - Carmen Kettler
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Christian Koeder
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Sarah Husain
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Corinna Anand
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Nora Schoch
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
| | - Heike Englert
- Department of Food, Nutrition, Facilities, University of Applied Sciences Münster, 48149 Münster, Germany; (C.K.); (C.K.); (S.H.); (C.A.); (N.S.); (H.E.)
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Llamas-Saez C, Saez-Vaquero T, Jiménez-García R, López-de-Andrés A, Carabantes-Alarcón D, Zamorano-León JJ, Cuadrado-Corrales N, Pérez-Farinos N, Wärnberg J. Cross Sectional and Case-Control Study to Assess Time Trend, Gender Differences and Factors Associated with Physical Activity among Adults with Diabetes: Analysis of the European Health Interview Surveys for Spain (2014 & 2020). J Clin Med 2023; 12:jcm12062443. [PMID: 36983443 PMCID: PMC10057052 DOI: 10.3390/jcm12062443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: We aim to assess the time trend from 2014 to 2020 in the prevalence of physical activity (PA), identify gender differences and sociodemographic and health-related factors associated with PA among people with diabetes, and compare PA between people with and without diabetes. (2) Methods: We conducted a cross-sectional and a case-control study using as data source the European Health Interview Surveys for Spain (EHISS) conducted in years 2014 and 2020. The presence of diabetes and PA were self-reported. Covariates included socio-demographic characteristics, health-related variables, and lifestyles. To compare people with and without diabetes, we matched individuals by age and sex. (3) Results: The number of participants aged ≥18 years with self-reported diabetes were 1852 and 1889 in the EHISS2014 and EHISS2020, respectively. The proportion of people with diabetes that had a medium or high frequency of PA improved from 48.3% in 2014 to 52.6% in 2020 (p = 0.009), with 68.5% in 2014 and 77.7% in 2020 being engaged in two or more days of PA (p < 0.001). Males with diabetes reported more PA than females with diabetes in both surveys. After matching by age and gender, participants with diabetes showed significantly lower engagement in PA than those without diabetes. Among adults with diabetes, multivariable logistic regression showed confirmation that PA improved significantly from 2014 to 2020 and that male sex, higher educational level, and better self-rated health were variables associated to more PA. However, self-reported comorbidities, smoking, or BMI > 30 were associated to less PA. (4) Conclusions: The time trend of PA among Spanish adults with diabetes is favorable but insufficient. The prevalence of PA in this diabetes population is low and does not reach the levels of the general population. Gender differences were found with significantly more PA among males with diabetes. Our result could help to improve the design and implementation of public health strategies to improve PA among people with diabetes.
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Affiliation(s)
- Carlos Llamas-Saez
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | | | - Rodrigo Jiménez-García
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Ana López-de-Andrés
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - David Carabantes-Alarcón
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - José J Zamorano-León
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, IdISSC, 28040 Madrid, Spain
| | - Napoleón Pérez-Farinos
- Epi-PHAAN Research Group, School of Medicine, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain
| | - Julia Wärnberg
- Epi-PHAAN Research Group, School of Health Sciences, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), 29071 Málaga, Spain
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Fiorini G, Pellegrini G, Franchi M, Pincelli AI, Rigamonti AE, Corrao G, Sartorio A, Cella SG. Pharmacological Treatment of Type-2-Diabetes and Cardiovascular Comorbidities: Differences between Undocumented Migrants and Natives in Italy. Healthcare (Basel) 2022; 11:healthcare11010004. [PMID: 36611464 PMCID: PMC9818502 DOI: 10.3390/healthcare11010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/12/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Diabetes prevalence is growing worldwide, especially in some populations. Though migrations seem to contribute to the presence in host countries of a significant number of patients with diabetes and its comorbidities, very little is known about the health conditions of undocumented migrants. We retrospectively studied 838 patients with type 2 diabetes mellitus (T2DM), 425 Italians followed by the diabetes clinic of a university hospital, and 413 undocumented migrants receiving assistance from a non-governmental organization. We analyzed their demographic and clinical data together with the medications they were on. The prevalence of the use of specific classes of drugs was compared between undocumented migrants and Italians by fitting a Poisson regression model, and the results were reported as prevalence rate ratios (PRRs) with a 95% confidence interval. Undocumented migrants with T2DM received fewer medications for cardiovascular (CV) conditions (PRR: 0.68, 0.60 to 0.76) than Italians, after correcting for confounding factors. Only sulfonylureas were more frequently used in undocumented migrants. The causes of these differences are not completely clear, but social, cultural, and economic factors can have an important role. More efforts are needed to provide appropriate treatment of diabetes and its CV comorbidities to undocumented migrants.
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Affiliation(s)
| | - Giacomo Pellegrini
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, 20126 Milan, Italy
| | | | - Antonello Emilio Rigamonti
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy
- Laboratory of Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano Bicocca, 20126 Milan, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Piancavallo-Verbania, Italy
| | - Silvano Gabriele Cella
- National Centre for Healthcare Research and Pharmacoepidemiology, 20126 Milan, Italy
- Laboratory of Clinical Pharmacology and Pharmacoepidemiology, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Correspondence:
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