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Background: Progression from prediabetes to type 2 diabetes can be prevented or slowed with cost-effective lifestyle interventions targeting weight loss through improved diet and increased physical activity. This study provides estimates of the potential long term economic implications to society and federal budget implications if implemented on a national scale in the U.S.

Methods and Findings: Using an epidemiologically-based microsimulation model, we analyzed the potential health and economic implications if a national lifestyle intervention patterned after the National Diabetes Prevention Program were implemented among the estimated 37.9 million overweight or obese adults age 40 to 70 whose prediabetes is either already diagnosed or whose diabetes might be detected under the recent national screening recommendations. Cumulative over ten years, the average medical savings ranged from $10,970 for adults ages 40-49 at time of intervention, to $15,250 for adults ages 65-70 at time of intervention. Cumulative over 20 years, population medical savings were highest ($21,840) for the age 40-49 population and lowest ($8,030) for the age 65-70 population reflecting that lifestyle intervention increases longevity which in turn increases lifetime medical expenditures. If one quarter of these 37.9 million adults (9.5 million) completed the intervention, then cumulative over 10 years there could be $121 billion lower medical expenditures, $219 billion higher economic output, 2.5 million fewer cases of diabetes, and 800,000 fewer deaths. Over 20 years societal economic benefits continue to grow, though Medicare and Social Security expenditures for the additional 1.5 million people alive offset almost all the cumulative Medicare savings and additional federal tax revenues.