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Randomized Controlled Trial
. 2023 Oct 1;183(10):1071-1079.
doi: 10.1001/jamainternmed.2023.3283.

Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes

Peter J Huckfeldt  1 , Jeffrey C Yu  2   3   4 , Paul K O'Leary  5 , Ann S M Harada  2   6 , Nicholas M Pajewski  7 , Chris Frenier  1   8 , Mark A Espeland  7   9 , Anne Peters  10 , Michael P Bancks  11 , Seth A Seabury  2   3 , Dana P Goldman  2   6
Affiliations
Randomized Controlled Trial

Association of Intensive Lifestyle Intervention for Type 2 Diabetes With Labor Market Outcomes

Peter J Huckfeldt et al. JAMA Intern Med. .

Abstract

Importance: An intensive lifestyle intervention (ILI) has been shown to improve diabetes management and physical function. These benefits could lead to better labor market outcomes, but this has not been previously studied.

Objective: To estimate the association of an ILI for weight loss in type 2 diabetes with employment, earnings, and disability benefit receipt during and after the intervention.

Design, setting, and participants: This cohort study included participants with type 2 diabetes and overweight or obesity and compared an ILI with a control condition of diabetes support and education. Data for the original trial were accrued from August 22, 2001, to September 14, 2012. Trial data were linked with Social Security Administration records to investigate whether, relative to the control group, the ILI was associated with improvements in labor market outcomes during and after the intervention period. Difference-in-differences models estimating relative changes in employment, earnings, and disability benefit receipt between the ILI and control groups were used, accounting for prerandomization differences in outcomes for linked participants. Outcome data were analyzed from July 13, 2020, to May 17, 2023.

Exposure: The ILI consisted of sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists on a weekly basis in the first 6 months, decreasing to a monthly basis by the fourth year, designed to achieve and maintain at least 7% weight loss. The control group received group-based diabetes education sessions 3 times annually during the first 4 years, with 1 annual session thereafter.

Main outcomes and measures: Employment and receipt of federal disability benefits (Supplemental Security Income and Social Security Disability Insurance), earnings, and disability benefit payments from 1994 through 2018.

Results: A total of 3091 trial participants were linked with Social Security Administration data (60.1% of 5145 participants initially randomized and 97.0% of 3188 of participants consenting to linkage). Among the 3091 with fully linked data, 1836 (59.4%) were women, and mean (SD) age was 58.4 (6.5) years. Baseline clinical and demographic characteristics were similar between linked participants in the ILI and control groups. Employment increased by 2.9 (95% CI, 0.3-5.5) percentage points for the ILI group relative to controls (P = .03) with no significant relative change in disability benefit receipt (-0.9 [95% CI, -2.1 to 0.3] percentage points; P = .13).

Conclusions and relevance: The findings of this cohort study suggest that an ILI to prevent the progression and complications of type 2 diabetes was associated with higher levels of employment. Labor market productivity should be considered when evaluating interventions to manage chronic diseases.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Huckfeldt reported receiving grant funding from the National Institute on Aging (NIA) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), the Agency for Healthcare Research and Quality, and the Robert Wood Johnson Foundation and contract funding from the Centers for Medicare & Medicaid Services during the conduct of the study. Dr Yu reported being employed by Alexion Pharmaceuticals. Dr Harada reported receiving grant funding from the NIH during the conduct of the study and being a prior employee of UnitedHealth Group, receiving stock as partial compensation. Dr Pajewski reported receiving grant funding from the NIDDK during the conduct of the study. Dr Frenier reported receiving grant funding from the Department of Health and Human Services, NIH, and NIDDK during the conduct of the study. Dr Espeland reported receiving grant funding from the NIH during the conduct of the study, receiving research funding from the Alzheimer’s Association, and is compensated for service on a Steering Committee for a study conducted by Nestle. Dr Peters reported receiving grant funding from the NIH during the conduct of the study and receiving consulting fees from Vertex, Abbott, Medscape, and Blue Circle Health; research support from Abbot and Insulet; and stock options from Omada Health and Teladoc outside the submitted work. Dr Bancks reported receiving grant funding from the NIDDK during the conduct of the study. Dr Seabury reported receiving grant funding from the NIDDK and the Agency for Healthcare Research and Quality during the conduct of the study. Dr Goldman reported receiving grant funding from the NIDDK during the conduct of the study and receiving grant funding from Amgen Inc, Blue Cross Blue Shield of Arizona, Bristol Myers Squibb, Cedars-Sinai Health System, Edwards Lifesciences, Gates Ventures, Genentech Inc, Gilead Sciences Inc, Johnson & Johnson, the Kaiser Family Foundation, Novartis AG, Pfizer Inc, F. Hoffmann–La Roche AG, and Walgreens Boots Alliance Inc; receiving personal fees from the National Railway Labor Conference and Biogen Inc; being a cofounder of EntityRisk with equity; and receiving travel support from The Aspen Institute outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flow Diagram
ILI indicates intensive lifestyle intervention.
Figure 2.
Figure 2.. Percentage of Employed Look AHEAD (Action for Health in Diabetes) Participants
The first vertical dashed line indicates the year prior to randomization and the second vertical dashed line indicates the median intervention length (10 years). ILI indicates intensive lifestyle intervention.
Figure 3.
Figure 3.. Percentage of Look AHEAD (Action for Health in Diabetes) Participants Receiving Disability
The first vertical dashed line indicates the year prior to randomization and the second vertical dashed line indicates the median intervention length (10 years). ILI indicates intensive lifestyle intervention.
See this image and copyright information in PMC

References

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