Projected Reduction of Diabetes- and Obesity-Related Complication Risks Following the 12-Week Weight-Loss Phase of the RESET Study.

Abstract

Background: Type 2 diabetes (T2D) and obesity increase individuals' risk of microvascular and macrovascular complications, which may increase healthcare costs. The RESET program combined low-calorie diet using diabetes-specific nutritional formula and a digital lifestyle behavior change program to target sustainable weight loss and improved diabetes management.

Objective: To quantify projected changes in diabetes-related complication risks following the 12-week weight-loss phase of the RESET program and to relate these modeled risk reductions to program costs.

Methods: Data from 157 adults with type 2 diabetes (mean age, 56 years; diabetes duration, 2.2 years; baseline body mass index (BMI), 35 kg/m²; HbA1c, 7.5%) completing the RESET weight-loss phase were analyzed. Observed mean changes in HbA1c, BMI, and systolic blood pressure were applied to the UK Prospective Diabetes Study Outcomes Model 2 (UKPDS-OM2) to estimate projected relative risk reductions in microvascular and macrovascular complications over a 3-month horizon. Program costs were derived using a microcosting approach from the healthcare payer perspective, and parameter uncertainty was evaluated through 20 000 Monte Carlo simulations.

Results: Participants achieved mean reductions of 1.0% in HbA1c, 11.0 kg in body weight, and 4.5 mmHg in systolic blood pressure. The model projected an overall relative reduction in total complication risk of 15.4% (95% confidence interval [CI], 9.1-21.4), corresponding to an absolute reduction of 1.9 projected events per 1000 participants over 3 months, comprising a -13.2% mean reduction in macrovascular and -23.8% in microvascular complication risks. Mean program cost was £1236 per participant (95% CI, £1001-£1492), corresponding to an incremental cost of £84 per 1% relative risk reduction.

Conclusions: Short-term, intensive weight loss achieved clinically meaningful improvements in HbA1c and body weight that were associated with favorable reductions in projected microvascular and macrovascular complications at modest cost. Absolute event reductions over 3 months were modest, and sustaining these improvements is essential to realize long-term clinical and economic benefit.