Comparing the Lifestyle Interventions for Prediabetes: An Integrated Microsimulation and Population Simulation Model

Area of Science:

• Public Health
• Preventive Medicine
• Health Economics

Background:

• Prediabetes affects a significant portion of the U.S. adult population, increasing their risk of developing type 2 diabetes.
• Lifestyle interventions are crucial for diabetes prevention, but their comparative effectiveness and cost-effectiveness require further investigation.

Purpose of the Study:

• To develop and utilize a stochastic simulation model to compare the population-level impacts of different lifestyle interventions for prediabetes.
• To identify the most effective and cost-effective interventions and optimal age groups for implementing these programs.

Main Methods:

• A stochastic simulation model was developed to replicate prediabetes and diabetes trends in the U.S. adult population from 1997-2010.
• The model simulated the long-term impacts (10, 15, and 30 years) of three lifestyle interventions: Diabetes Prevention Program (DPP), DPP-YMCA, and Healthy Living Partnerships to Prevent Diabetes (HELP-PD).

Main Results:

• The model accurately replicated temporal trends in U.S. adult diabetes incidence.
• Over 15 years, HELP-PD showed the greatest reduction in diabetes incidence (0.4 per 1,000) compared to DPP (0.3) and DPP-YMCA (0.2), relative to no intervention.
• HELP-PD was identified as the most cost-effective intervention, projecting $38 billion in 10-year savings for individuals aged 25-65, assuming full participation and considering achievement rates.

Conclusions:

• Lifestyle interventions significantly reduce diabetes incidence among prediabetes individuals.
• The Healthy Living Partnerships to Prevent Diabetes (HELP-PD) program demonstrates superior cost-effectiveness and impact compared to DPP and DPP-YMCA.
• The simulation model can inform targeted public health strategies for diabetes prevention in specific populations and age groups.