Abstract：
BACKGROUND: Type 2 diabetes mellitus and overweight/obesity increase healthcare costs. Both are also associated with accelerated aging. However, the contributions of this accelerated aging to increased healthcare costs are unknown.
METHODS: We use data from a 8-year longitudinal cohort followed at 16 U.S. clinical research sites. Participants were adults aged 45-76 years with established type 2 diabetes and overweight or obesity who had enrolled in the Action for Health in Diabetes clinical trial. They were randomly (1:1) assigned to either an intensive lifestyle intervention focused on weight loss versus a comparator of diabetes support and education. A validated deficit accumulation frailty index (FI) was used to characterize biological aging. Discounted annual healthcare costs were estimated using national databases in 2012 dollars. Descriptive characteristics were collected by trained and certified staff.
RESULTS: Compared with participants in the lowest tertile (least frail) of baseline FI, those in the highest tertile (most frail) at Year 1 averaged $714 (42%) higher medication costs, $244 (22%) higher outpatient costs, and $800 (134%) higher hospitalization costs (p < 0.001). At Years 4 and 8, relatively greater increases in FI (third vs. first tertile) were associated with an approximate doubling of total healthcare costs (p < 0.001). Mean (95% confidence interval) relative annual savings in healthcare costs associated with randomization to the intensive lifestyle intervention were $437 ($195, $579) per year during Years 1-4 and $461 ($232, $690) per year during Years 1-8. These were attenuated and the 95% confidence interval no longer excluded $0 after adjustment for the annual FI differences from baseline.
CONCLUSIONS: Deficit accumulation frailty tracks well with healthcare costs among adults with type 2 diabetes and overweight or obesity. It may serve as a useful marker to project healthcare needs and as an intermediate outcome in clinical trials.
METHODS: We use data from a 8-year longitudinal cohort followed at 16 U.S. clinical research sites. Participants were adults aged 45-76 years with established type 2 diabetes and overweight or obesity who had enrolled in the Action for Health in Diabetes clinical trial. They were randomly (1:1) assigned to either an intensive lifestyle intervention focused on weight loss versus a comparator of diabetes support and education. A validated deficit accumulation frailty index (FI) was used to characterize biological aging. Discounted annual healthcare costs were estimated using national databases in 2012 dollars. Descriptive characteristics were collected by trained and certified staff.
RESULTS: Compared with participants in the lowest tertile (least frail) of baseline FI, those in the highest tertile (most frail) at Year 1 averaged $714 (42%) higher medication costs, $244 (22%) higher outpatient costs, and $800 (134%) higher hospitalization costs (p < 0.001). At Years 4 and 8, relatively greater increases in FI (third vs. first tertile) were associated with an approximate doubling of total healthcare costs (p < 0.001). Mean (95% confidence interval) relative annual savings in healthcare costs associated with randomization to the intensive lifestyle intervention were $437 ($195, $579) per year during Years 1-4 and $461 ($232, $690) per year during Years 1-8. These were attenuated and the 95% confidence interval no longer excluded $0 after adjustment for the annual FI differences from baseline.
CONCLUSIONS: Deficit accumulation frailty tracks well with healthcare costs among adults with type 2 diabetes and overweight or obesity. It may serve as a useful marker to project healthcare needs and as an intermediate outcome in clinical trials.
摘要：
背景：2型糖尿病和超重/肥胖会增加医疗费用。两者都与加速衰老有关。然而,这种加速老龄化对医疗费用增加的贡献尚不清楚.
方法：我们使用来自16个美国临床研究中心的8年纵向队列的数据。参与者是45-76岁的成年人，患有2型糖尿病和超重或肥胖，他们参加了糖尿病健康行动临床试验。他们被随机（1：1）分配到集中于减肥的强化生活方式干预与糖尿病支持和教育的比较。使用经过验证的赤字积累脆弱指数（FI）来表征生物衰老。使用国家数据库以2012年美元估算了年度医疗保健费用的折扣。描述性特征由经过培训和认证的工作人员收集。
结果：与基线FI最低（最弱）的参与者相比，第一年最高三元(最脆弱)的人平均药费高出714美元(42%)，门诊费用增加244美元（22%），住院费用增加800美元（134%）（p<0.001）。在第4年和第8年，FI的增长相对较大(第三与第一三位数)与医疗总费用大约翻倍相关(p<0.001)。在第1-4年期间，与随机分配到强化生活方式干预相关的医疗费用的平均（95％置信区间）每年节省437美元（195美元，579美元），在第1-8年期间每年节省461美元（232美元，690美元）。这些都是衰减和95％的置信区间不再排除$0调整后的年度FI差异从基线。
结论：在患有2型糖尿病和超重或肥胖的成年人中，赤字积累脆弱与医疗费用密切相关。它可以作为预测医疗保健需求的有用标记，也可以作为临床试验的中间结果。
方法：我们使用来自16个美国临床研究中心的8年纵向队列的数据。参与者是45-76岁的成年人，患有2型糖尿病和超重或肥胖，他们参加了糖尿病健康行动临床试验。他们被随机（1：1）分配到集中于减肥的强化生活方式干预与糖尿病支持和教育的比较。使用经过验证的赤字积累脆弱指数（FI）来表征生物衰老。使用国家数据库以2012年美元估算了年度医疗保健费用的折扣。描述性特征由经过培训和认证的工作人员收集。
结果：与基线FI最低（最弱）的参与者相比，第一年最高三元(最脆弱)的人平均药费高出714美元(42%)，门诊费用增加244美元（22%），住院费用增加800美元（134%）（p<0.001）。在第4年和第8年，FI的增长相对较大(第三与第一三位数)与医疗总费用大约翻倍相关(p<0.001)。在第1-4年期间，与随机分配到强化生活方式干预相关的医疗费用的平均（95％置信区间）每年节省437美元（195美元，579美元），在第1-8年期间每年节省461美元（232美元，690美元）。这些都是衰减和95％的置信区间不再排除$0调整后的年度FI差异从基线。
结论：在患有2型糖尿病和超重或肥胖的成年人中，赤字积累脆弱与医疗费用密切相关。它可以作为预测医疗保健需求的有用标记，也可以作为临床试验的中间结果。
