Clinical similarity, economic divergence: cost-effectiveness and population health implications of dietary, pharmacological, and exercise interventions in older adults with type 2 diabetes: a secondary analysis of a randomized controlled trial
Abstract
Population ageing is increasing the burden of chronic disease and frailty, raising important questions regarding how health systems define and allocate value. While pharmacological treatments dominate clinical care, lifestyle-based interventions may offer broader benefits for healthy ageing. However, integrated clinical and economic evidence in older populations remains limited.
We conducted a secondary analysis of the CEV-65 randomized controlled trial (
n
= 100 older adults aged 65 years and older with type 2 diabetes), comparing a Mediterranean diet (VegMedD), pharmacological treatment (empagliflozin), and exercise (circuit resistance training). Outcomes included changes in glycemic control (HbA1c) and frailty, alongside a composite responder measure. Economic evaluation included trial-based cost-effectiveness analyses (using the composite responder outcome based on improvement in both HbA1c and frailty) and cost–utility analyses using quality-adjusted life years (QALYs) derived from SF-12 data via a validated mapping approach. Adjusted regression models, propensity score weighting, and probabilistic sensitivity analyses were applied. Scenario analyses assessed sensitivity to pharmacological pricing assumptions.
All interventions improved glycemic control, with no statistically significant between-group differences. Frailty improvements were modest. Pharmacological treatment achieved the highest responder rate, whereas non-pharmacological interventions were substantially…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 100 participants or records.
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