SpringerLink
Log in

Costs of diabetes medication among male former elite athletes in later life

  • Original Article
  • Published:
Acta Diabetologica Aims and scope Submit manuscript

Abstract

Aims

Regular physical activity plays a major role, in both prevention and treatment of type 2 diabetes. Less is known whether vigorous physical activity during young adulthood is associated with costs of diabetes medication in later life. The aim of this study is to evaluate this question.

Methods

The study population consisted of 1314 former elite-class athletes and 860 matched controls. The former athletes were divided into three groups based on their active career sport: endurance, mixed and power sports. Information on purchases of diabetes medication between 1995 and 2009 was obtained from the drug purchase register of the Finnish Social Insurance Institution.

Results

The total cost of diabetes medication per person year was significantly lower among the former endurance (mean 81 € [95% CI 33–151 €]) and mixed group athletes (mean 272 € [95% CI 181–388 €]) compared with the controls (mean 376 € [95% CI 284–485 €]), (p < 0.001 and p = 0.045, respectively). Of the former endurance athletes, 0.4% used insulin, while 5.2% of the controls used insulin (p = 0.018).

Conclusions

A career as former endurance, sprint, jumper or team game athlete seems to reduce the costs of diabetes medication in later life.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. International Diabetes Federation (2015) IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation. http://www.diabetesatlas.org. Accessed 27 Sept 2016

  2. Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS Jr (1991) Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 325:147–152

    Article  CAS  PubMed  Google Scholar 

  3. Lynch J, Helmrich SP, Lakka TA et al (1996) Moderately intense physical activities and high levels of cardiorespiratory fitness reduce the risk of non-insulin-dependent diabetes mellitus in middle-aged men. Arch Intern Med 156:1307–1314

    Article  CAS  PubMed  Google Scholar 

  4. Pan XR, Li GW, Hu YH et al (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and diabetes study. Diabetes Care 20:537–544

    Article  CAS  PubMed  Google Scholar 

  5. Tuomilehto J, Lindstrom J, Eriksson JG et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:1343–1350

    Article  CAS  PubMed  Google Scholar 

  6. Knowler WC, Barrett-Connor E, Fowler SE et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403

    Article  CAS  PubMed  Google Scholar 

  7. Espeland MA, Glick HA, Bertoni A, Look AHEAD Research Group et al (2014) Impact of an intensive lifestyle intervention on use and cost of medical services among overweight and obese adults with type 2 diabetes: the action for health in diabetes. Diabetes Care 37:2548–2556

    Article  PubMed  PubMed Central  Google Scholar 

  8. Paffenbarger RS Jr, Jung DL, Leung RW, Hyde RT (1991) Physical activity and hypertension: an epidemiological view. Ann Med 23:319–327

    Article  PubMed  Google Scholar 

  9. Laine MK, Eriksson JG, Kujala UM et al (2014) A former career as a male elite athlete-does it protect against type 2 diabetes in later life? Diabetologia 57:270–274

    Article  CAS  PubMed  Google Scholar 

  10. Umpierre D, Ribeiro PAB, Kramer CK et al (2011) Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes. JAMA 305:1790–1799

    Article  CAS  PubMed  Google Scholar 

  11. McGinley SK, Armstrong MJ, Boule NG, Sigal RJ (2015) Effects of exercise training using resistance bands on glycaemic control and strenght in type 2 diabetes mellitus: a meta-analysis of randomised controlled trials. Acta Diabetol 52:221–230

    Article  PubMed  Google Scholar 

  12. Liubaoerji** Y, Terada T, Fletcher K, Boule NG (2016) Effect of aerobic intensity on glycemic control in type 2 diabetes: a meta-analysis of head-to-head randomized trials. Acta Diabetol 53:769–781

    Article  CAS  PubMed  Google Scholar 

  13. Chacko E (2016) Timing, intensity and frequency of exercise for glucose control. Acta Diabetol. doi:10.1007/s00592-016-0886-5

    PubMed  Google Scholar 

  14. Boule NG, Liubaoerji** Y, Terada T (2016) Reply to Elsamma Chacko: “ timing, intensity and frequency of exercise for glucose control”. Acta Diabetol. doi:10.1007/s00592-016-0887-4

    Google Scholar 

  15. Balducci S, Vulpiani MC, Pugliese L et al (2014) Effect of supervised exercise training on musculoskeletal symptoms and function in patients with type 2 diabetes: the Italian Diabetes Exercise Study (IDES). Acta Diabetol 51:647–654

    Article  PubMed  Google Scholar 

  16. Sarna S, Sahi T, Koskenvuo M, Kaprio J (1993) Increased life expectancy of world class male athletes. Med Sci Sports Exerc 25:237–244

    Article  CAS  PubMed  Google Scholar 

  17. Åstrand P, Rodahl K (1986) Physiological bases of exercise. In: Textbook of work physiology. McGraw Hill, New York, pp 412–415

    Google Scholar 

  18. WHO (2003) Introduction to drug utilization research. apps.who.int/medicinedocs/en/d/Js4876e/. Accessed 27 Sept 2016

  19. Consumer price index (e-publication). ISSN = 1799–0254. Helsinki: Statistics Finland. Available at: http://www.stat.fi/til/khi/men_en.html. Accessed 27 Sept 2016

  20. Classification of Occupations (2010). Available at: http://stat.fi/meta/luokitukset/ammatti/001-2010/index_en.html. Accessed 27 Sept 2016

  21. Kujala UM, Sarna S, Kaprio J (2003) Use of medications and dietary supplements in later years among male former top-level athletes. Arch Intern Med 163:1064–1068

    Article  PubMed  Google Scholar 

  22. Sarna S, Kaprio J, Kujala UM, Koskenvuo M (1997) Health status of former elite athletes. The Finnish experience. Aging (Milano) 9:35–41

    CAS  Google Scholar 

  23. Alouki K, Delisle H, Bermudez-Tamayo C, Johri M (2016) Lifestyle interventions to prevent type 2 diabetes: a systematic review of economic evaluation studies. J Diabetes Res. doi:10.1155/2016/2159890

    PubMed  PubMed Central  Google Scholar 

  24. Palmer AJ, Roze S, Valentine WJ, Spinas GA, Shaw JE, Zimmet PZ (2004) Intensive lifestyle changes or metformin in patients with impaired glucose tolerance: modeling the long-term health economic implications of the diabetes prevention program in Australia, France, Germany, Switzerland, and the United Kingdom. Clin Ther 26:304–321

    Article  PubMed  Google Scholar 

  25. Diabetes Prevention Program Research Group (2012) The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS. Diabetes Care 35:723–730

    Article  Google Scholar 

  26. Liu X, Li C, Gong H et al (2013) An economic evaluation for prevention of diabetes mellitus in a develo** country: a modelling study. BMC Public Health. doi:10.1186/1471-2458-13-729

    Google Scholar 

  27. Saha S, Carlsson KS, Gerdtham UG et al (2013) Are lifestyle interventions in primary care cost-effective?—An analysis based on a Markov model, differences-in-differences approach and the Swedish Bjorknas study. PLoS ONE. doi:10.1371/journal.pone.0080672

    Google Scholar 

  28. Bertram MY, Lim SS, Barendregt JJ, Vos T (2010) Assessing the cost-effectiveness of drug and lifestyle intervention following opportunistic screening for pre-diabetes in primary care. Diabetologia 53:875–881

    Article  CAS  PubMed  Google Scholar 

  29. Balducci S, Sacchetti M, Haxhi J et al (2014) Physical exercise as therapy for type 2 diabetes mellitus. Diabetes Metab Res Rev. doi:10.1002/dmrr.2514

    Google Scholar 

  30. Kujala UM (2011) Physical activity, genes, and lifetime predisposition to chronic disease. European review of aging and physical activity: 31–36

  31. Colberg SR, Sigal RJ, Fernhall B et al (2010) Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care 33:2692–2696

    Article  PubMed  PubMed Central  Google Scholar 

  32. Yusuf S, Reddy S, Ounpuu S, Anand S (2001) Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 104:2746–2753

    Article  CAS  PubMed  Google Scholar 

  33. Andersen P, Saltin B (1985) Maximal perfusion of skeletal muscle in man. J Physiol 366:233–249

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Richter EA, Hargreaves M (2013) Exercise, GLUT4, and skeletal muscle glucose uptake. Physiol Rev 93:993–1017

    Article  CAS  PubMed  Google Scholar 

  35. Christ-Roberts CY, Pratipanawatr T, Pratipanawatr W et al (2004) Exercise training increases glycogen synthase activity and GLUT4 expression but not insulin signaling in overweight nondiabetic and type 2 diabetic subjects. Metabolism 53:1233–1242

    Article  CAS  PubMed  Google Scholar 

  36. Costill DL, Fink WJ, Pollock ML (1976) Muscle fiber composition and enzyme activities of elite distance runners. Med Sci Sports 8:96–100

    CAS  PubMed  Google Scholar 

  37. Lundsgaard AM, Kiens B (2014) Gender differences in skeletal muscle substrate metabolism—molecular mechanisms and insulin sensitivity. Front Endocrinol. doi:10.3389/fendo.2014.00195

    Google Scholar 

  38. Phielix E, Meex R, Ouwens DM et al (2012) High oxidative capacity due to chronic exercise training attenuates lipid-induced insulin resistance. Diabetes 61:2472–2478

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Aadahl M, Kjaer M, Jorgensen T (2007) Associations between overall physical activity level and cardiovascular risk factors in an adult population. Eur J Epidemiol 22:369–378

    Article  PubMed  Google Scholar 

  40. Philipsen A, Hansen AL, Jorgensen ME et al (2015) Associations of objectively measured physical activity and abdominal fat distribution. Med Sci Sports Exerc 47:983–989

    Article  PubMed  Google Scholar 

  41. Shojaee-Moradie F, Baynes KC, Pentecost C et al (2007) Exercise training reduces fatty acid availability and improves the insulin sensitivity of glucose metabolism. Diabetologia 50:404–413

    Article  CAS  PubMed  Google Scholar 

  42. Johnson NA, Sachinwalla T, Walton DW et al (2009) Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss. Hepatology 50:1105–1112

    Article  CAS  PubMed  Google Scholar 

  43. van der Heijden GJ, Wang ZJ, Chu ZD et al (2010) A 12-week aerobic exercise program reduces hepatic fat accumulation and insulin resistance in obese, Hispanic adolescents. Obesity 18:384–390

    Article  PubMed  Google Scholar 

  44. Kujala UM, Jokelainen J, Oksa H et al (2011) Increase in physical activity and cardiometabolic risk profile change during lifestyle intervention in primary healthcare: 1-year follow-up study among individuals at high risk for type 2 diabetes. BMJ Open. doi:10.1136/bmjopen-2011-000292

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We would like to thank the National Institute for Health and Welfare, Department of Public Health, University of Helsinki; Department of Health Sciences, University of Jyväskylä; Paavo Nurmi Centre, Turku and Orton Research Institute, Invalid Foundation, Helsinki for collaboration during the large epidemiological research programme.

Funding

The study was funded by the Ministry of Education and Culture, the Juho Vainio Foundation, the Finnish Heart Research Foundation, the Paavo Nurmi Foundation, the Finnish Cultural Foundation and by a grant from Medical Society of Finland, Finska Läkaresällskapet.

Authors contribution

All authors contributed to the development of the research, interpretation of the data, drafting of the manuscript and approved the final version. ML wrote the manuscript. RK worked up with the data. HK analysed the data.

Author information

Authors and Affiliations

  1. Department of General Practice and Primary Health Care, Helsinki University Hospital, University of Helsinki, Tukholmankatu 8 B, PL 20, 00140, Helsinki, Finland

    M. K. Laine & J. G. Eriksson

  2. Vantaa Health Center, Vantaa, Finland

    M. K. Laine

  3. Department of Computer Science, Aalto University, Espoo, Finland

    R. Kujala

  4. Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland

    J. G. Eriksson

  5. Folkhälsan Research Center, Helsinki, Finland

    J. G. Eriksson

  6. Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland

    H. Kautiainen

  7. Department of Public Health, University of Helsinki, Helsinki, Finland

    S. Sarna

  8. Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland

    U. M. Kujala

Authors
  1. M. K. Laine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Kujala
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. G. Eriksson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Kautiainen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Sarna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. U. M. Kujala
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. K. Laine.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

The ethics committee of the Hospital District of Helsinki and Uusimaa approved the study.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

All participants have provided written informed consent.

Additional information

Managed by Antonio Secchi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Laine, M.K., Kujala, R., Eriksson, J.G. et al. Costs of diabetes medication among male former elite athletes in later life. Acta Diabetol 54, 335–341 (2017). https://doi.org/10.1007/s00592-016-0947-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00592-016-0947-9

Keywords

Search

Navigation