The Rising Cost of Diabetes: Can DiRECT Tip the Scales?

The cost of treating diabetes mellitus has risen sharply in recent years because of an increasing number of patients with type 2 diabetes and obesity and a rapidly expanding repertoire of expensive nongeneric medications. Despite the call for a new treatment paradigm by the American Diabetes Association to mitigate this cost, recent Medicare Part D expenditure data show that this call remains unanswered. The Diabetes Remission Clinical Trial, published in The Lancet, adds support to a different path, demonstrating success with intensive lifestyle intervention followed by structured support for long-term weight loss maintenance. Nearly half of patients enrolled were able to achieve remission of their diabetes with hemoglobin A1c < 6.5% and an improvement of their quality of life. Although only from one trial, and of limited duration, these results should provide optimism for providers and patients alike and support future work toward an evidence base for non–medication-based management of diabetes.