Real-World Evaluation of the Effects of Counseling and Education in Diabetes Management

Abstract

Background. Patient education has long been recognized as a component of effective diabetes management, but the impact of counseling and education (C/E) interventions on health care costs is not fully understood.Objectives. To identify the incidence and type of diabetes C/E received by type 2 diabetes patients and to evaluate associated economic and clinical outcomes.Methods. This retrospective cohort study used the Premier-Optum Continuum of Care database (2005–2009) to compare adult patients with type 2 diabetes receiving C/E to those not receiving C/E (control). The index date was the first C/E date or, in the control cohort, a randomly assigned date on which some care was delivered. Patients had at least 6 months’ pre-index and 12 months’ post-index continuous health plan coverage. Health care costs and glycemic levels were evaluated over 12 and 6 months, respectively, with adjustment for differences in baseline characteristics using propensity score matching (PSM).Results. Of 26,790 patients identified, 9.3% received at least one C/E intervention (mean age 53 years, 47% men) and 90.7% received no C/E (mean age 57 years, 54% men). Standard diabetes education was the most common form of C/E (73%). After PSM, C/E patients had some improvements in glycemic levels (among those with laboratory values available), without increased risk for hypoglycemia, and incurred $2,335 per-patient less in diabetes-related health care costs, although their total health care costs increased.Conclusions. Despite the low uptake of C/E services, C/E interventions may be associated with economic and clinical benefits at 12 months. Further analyses are needed to evaluate the long-term cost-effectiveness of such initiatives.

Self-Management Education and Support

“…A large population-based cohort study of 27,278 people with type 2 diabetes and no known previous cardiovascular disease (CVD) found that attending structured diabetes education was associated with a reduction in: allcause mortality of 44%, first CVD episode of 20% and stroke of 30% (12). A large retrospective cohort study of 26,790 individuals who had had at least 1 diabetes education session demonstrated lower diabetes-related health-care expenditures after 12 months compared to individuals who did not receive diabetes education (13). Improved quality of life has also been demonstrated (14), in addition to sustained weight loss and CV fitness for up to 4 years following education (15).…”

Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes

“…We found that early hypoglycaemia occurred in 9.1% of Medicare patients with type 2 diabetes who initiated BI. The real rate of hypoglycaemia is probably even higher as hypoglycaemia events that were not captured in claims data were not included, with the result that the incidence of hypoglycaemia is underreported . The risk for early hypoglycaemia was significantly associated with female sex, LIS status, inpatient resource use, higher aDCSI, presence of connective tissue/rheumatic disease, and hypoglycaemia during the baseline period.…”

“…Additionally, claims data do not include clinical details and, therefore, fail to capture important disease indicators, such as HbA1c and renal function markers. Furthermore, claims data are often inherently prone to underrepresenting hypoglycaemia as only ICD‐9‐CM/ICD‐10‐CM codes associated with a healthcare encounter are captured . In addition, this was an observational study instead of a randomized controlled trial.…”

“…The real rate of hypoglycaemia is probably even higher as hypoglycaemia events that were not captured in claims data were not included, with the result that the incidence of hypoglycaemia is underreported. 19,25 The risk for early hypoglycaemia was significantly associated with female sex, LIS status, inpatient resource use, higher aDCSI, presence of connective tissue/rheumatic disease, and hypoglycaemia during the baseline period. Some of these factors, such as prior hypoglycaemia, have been associated with hypoglycaemia risk in previous studies.…”

“…Furthermore, claims data are often inherently prone to underrepresenting hypoglycaemia as only ICD-9-CM/ICD-10-CM codes associated with a healthcare encounter are captured. 19,25,31 In addition, this was an observational study instead of a randomized controlled trial. If there are unmeasured confounders, such as disease severity, that correlated with early hypoglycaemia and adherence/persistence outcomes, the estimated correlation between hypoglycaemia and outcomes will be biased.…”