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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a secondary analysis of the CEV-65 randomized controlled trial (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009100 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\u2013utility 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 less costly. In cost-effectiveness analysis, lifestyle interventions were associated with lower costs but reduced responder-based effectiveness. In contrast, cost\u2013utility analysis indicated that both dietary and exercise interventions were economically dominant, yielding lower costs and higher QALYs under current pricing conditions. The dietary intervention demonstrated the highest probability of cost-effectiveness across conventional willingness-to-pay thresholds. Scenario analyses showed that responder-based conclusions were sensitive to pharmacological pricing, whereas cost\u2013utility findings remained comparatively robust.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Interventions with similar short-term clinical outcomes may differ substantially in their economic and population health value. Within the short-term trial horizon, lifestyle-based strategies were associated with more favorable cost\u2013utility profiles. These findings should be interpreted as exploratory and should not be extrapolated to long-term comparative effectiveness, particularly given the established long-term cardiovascular and renal benefits of SGLT2 inhibitors that could not be captured within the 10-week follow-up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov (Identifier: NCT03560375; registered on June 5, 2018)\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03560375?tab=history\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/study\/NCT03560375?tab=history<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12877-026-07994-7","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T02:33:03Z","timestamp":1784946783000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3030-4019","authenticated-orcid":false,"given":"Limor Dina","family":"Gonen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assaf","family":"Buch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Eldor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Yaish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Barak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"issue":"10033","key":"7994_CR1","doi-asserted-by":"publisher","first-page":"2145","DOI":"10.1016\/S0140-6736(15)00516-4","volume":"387","author":"JR Beard","year":"2016","unstructured":"Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel J-P, Lloyd-Sherlock P, Epping-Jordan JE, Peeters GMEEG, Mahanani WR, Thiyagarajan JA, Chatterji S. 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