Economic Impact and Health Care Utilization Outcomes of Diabetes Self-Management Education and Support Interventions for Persons With Diabetes: A Systematic Review and Recommendations for Future Research
Restricted accessResearch articleFirst published online December, 2021
Economic Impact and Health Care Utilization Outcomes of Diabetes Self-Management Education and Support Interventions for Persons With Diabetes: A Systematic Review and Recommendations for Future Research
Value-driven outcomes are important because health systems determine sustainability of diabetes self-management education and support (DSMES) programming. Health care utilization and clinical outcomes are critical factors when considering the impact of DSMES programs.
Objective
The aim of this systematic review was to describe studies that report on the economic and health care utilization outcomes of diabetes self-management programs.
Methods
A systematic literature review was performed in multiple databases. Studies reporting economic and health care utilization outcomes related to DSMES and including 1 or more of the ADCES7 Self-Care BehaviorsTM from January 2006 to May 2020 were included. Eligible articles needed to compare the intervention and comparison group and report on economic impact. The methodological quality was assessed with the Joanna Briggs Institute Critical Appraisal Checklist specific to each individual study design.
Results
A total of 22 of 14 556 articles published between 2007 and 2020 were included. Cost benefits varied, and there were considerable methodological heterogeneity among design, economic measures, population, perspective, intervention, and biophysical outcomes.
Conclusion
DSMES interventions may positively impact economic outcomes and/or health care utilization, although not all studies showed consistent benefit. This review highlights an evidence gap, and future health economic evaluations are warranted.
RowleyWRBezoldCArikanYByrneEKroheS.Diabetes 2030: insights from yesterday, today, and future trends. Popul Health Manag. 2017;20(1):6-12. doi:10.1089/pop.2015.0181
GeissLSLiYHoraIAlbrightARolkaDGreggEW. Resurgence of diabetes-related nontraumatic lower-extremity amputation in the young and middle-aged adult U.S. population. Diabetes Care. 2019;42(1):50-54. doi:10.2337/dc18-1380
5.
AlicicRZRooneyMTTuttleKR. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017;12(12):2032-2045. doi:10.2215/CJN.11491116
6.
American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care. 2018;41(5):917-928. doi:10.2337/dci18-0007
7.
U.S. House of Representatives. Report of the Committee on the Budget to Accompany H.R. 2015. Washington, DC: U.S. House of Representative; 1997. Report No. 105-149. Accessed September 20, 2021. https://www.congress.gov/105/crpt/hrpt149/CRPT-105hrpt149.pdf
8.
Association of Diabetes Care & Education Specialists; Kolb L. An effective model of diabetes care and education: the ADCES7 Self-Care BehaviorsTM. Sci Diabetes Self Manag Care. 2021;47(1):30-53. doi:10.1177/0145721720978154
GarberAJHandelsmanYGrunbergerG, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm – 2020 executive summary. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2020;26(1):107-139. doi:10.4158/CS-2019-0472
11.
American Diabetes Association. 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes—2021. Diabetes Care. 2021;44(suppl 1):S53-S72. doi:10.2337/dc21-S005
12.
MarreroDGArdJDelamaterAM, et al. Twenty-first century behavioral medicine: a context for empowering clinicians and patients with diabetes: a consensus report. Diabetes Care. 2013;36(2):463-470. doi:10.2337/dc12-2305
13.
ChrvalaCASherrDLipmanRD. Diabetes self-management education for adults with type 2 diabetes mellitus: a systematic review of the effect on glycemic control. Patient Educ Couns. 2016;99(6):926-943. doi:10.1016/j.pec.2015.11.003
14.
StrattonIMAdlerAINeilHAW, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321(7258):405-412.
15.
BorenSAFitznerKAPanhalkarPSSpeckerJE. Costs and benefits associated with diabetes education a review of the literature. Diabetes Educ. 2009;35(1):72-96. doi:10.1177/01457 21708326774
16.
TeljeurCMoranPSWalsheS, et al. Economic evaluation of chronic disease self-management for people with diabetes: a systematic review. Diabet Med. 2017;34(8):1040-1049. doi:10.1111/dme.13281
17.
SiegelKRAliMKZhouX, et al. Cost-effectiveness of interventions to manage diabetes: has the evidence changed since 2008?Diabetes Care. 2020;43(7):1557-1592. doi:10.2337/dci20-0017
WhitehouseCLitchmanMHaydon-GreattingS, et al. Systematic review and meta-analysis of the economic impact of diabetes education on healthcare expenditures among adults with diabetes in the United States. PROSPERO. 2020;CRD42020166743. Accessed September 20, 2021. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166743
20.
Covidence [Computer software]. Version accessed September 20, 2021. Melbourne, Australia: Veritas Health Innovation. Available at covidence.org.
Streak GomersallJTertilus JadotteYXueYLockwoodSRiddleDPredaA. Chapter 6: Systematic reviews of economic evidence. In: AromatarisEMunnZ, eds. JBI Manual for Evidence Synthesis. 2014. Accessed September 20, 2021. https://doi.org/10.46658/JBIMES-20-07.
23.
MoherDLiberatiATetzlaffJAltmanD. Preferred reporting items for systematic reviews and meta-analysis: the PRISMA statement. BMJ. 2009;339:b2535. doi:10.1136/bmj.b2535
24.
RosenzweigJLTaitelMSNormanGKMooreTJTurenneWTangP. Diabetes disease management in Medicare Advantage reduces hospitalizations and costs. Am J Manag Care. 2010;16(7): e157-e162.
25.
CranorCWChristensenDB. The Asheville project: short-term outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc. 2012;52(6):838-850. doi:10.1331/JAPhA.2012.12542
26.
MageeMFBakerKMFernandezSJ, et al. Redesigning ambulatory care management for uncontrolled type 2 diabetes: a prospective cohort study of the impact of a Boot Camp model on outcomes. BMJ Open Diabetes Res Care. 2019;7(1):e000731. doi:10.1136/bmjdrc-2019-000731
27.
TurnerRMMaQLorigKGreenbergJDeVriesAR. Evaluation of a diabetes self-management program: claims analysis on comorbid illnesses, health care utilization, and cost. J Med Internet Res. 2018;20(6):e207. doi:10.2196/jmir.9225
28.
BergGDWadhwaS. Diabetes disease management results in Hispanic Medicaid patients. J Health Care Poor Underserved. 2009;20(2):432-443. doi:10.1353/hpu.0.0131
29.
DalalMRRobinsonSBSullivanSD. Real-world evaluation of the effects of counseling and education in diabetes management. Diabetes Spectr. 2014;27(4):235-243. doi:10.2337/diaspect .27.4.235
30.
DuncanIBirkmeyerCCoughlinSLiQSherrDBorenS. Assessing the value of diabetes education. Diabetes Educ. 2009;35(5):752-760. doi:10.1177/0145721709343609
31.
GilmerTPRozeSValentineWJ, et al. Cost-effectiveness of diabetes case management for low-income populations: cost-effectiveness of diabetes case management. Health Serv Res. 2007;42(5):1943-1959. doi:10.1111/j.1475-6773.2007.00701.x
32.
KoJJLuJRascatiK, et al. Analysis of glycemic control of a pharmacist-led medication management program in patients with type 2 diabetes. J Manag Care Spec Pharm. 2016;22(1):32-37. doi:10.18553/jmcp.2016.22.1.32
33.
BurtonJEgglestonBBrennerJTruchilAZulkiewiczBALewisMA. Community-based health education programs designed to improve clinical measures are unlikely to reduce short-term costs or utilization without additional features targeting these outcomes. Popul Health Manag. 2017;20(2):93-98. doi:10.1089/pop.2015.0185
34.
FeraTBlumlBMEllisWM. Diabetes ten city challenge: final economic and clinical results. J Am Pharm Assoc. 2009;49(3):383-391. doi:10.1331/JAPhA.2009.09015
35.
McLendonSFWoodFGStanleyN. Enhancing diabetes care through care coordination, telemedicine, and education: evaluation of a rural pilot program. Public Health Nurs. 2019;36(3):310-320. doi:10.1111/phn.12601
36.
MonteSVSlazakEMAlbaneseNPAdelmanMRaoGPaladinoJA. Clinical and economic impact of a diabetes clinical pharmacy service program in a university and primary care-based collaboration model. J Am Pharm Assoc. 2009;49(2):200-208. doi:10.1331/JAPhA.2009.08160
37.
RodriguezdeBittnerMChirikovVVBreunigIMZaghabRWShayaFT. Clinical effectiveness and cost savings in diabetes care, supported by pharmacist counselling. J Am Pharm Assoc. 2017;57(1):102-108.e4. doi:10.1016/j.japh.2016.08.010
38.
WertzDHouLDeVriesA, et al. Clinical and economic outcomes of the Cincinnati Pharmacy Coaching Program for diabetes and hypertension. Manag Care. 2012;21(3):44-54.
39.
WilhideCHayesJRFarahJR. Impact of behavioral adherence on clinical improvement and functional status in a diabetes disease management program. Dis Manag. 2008;11(3):169-175. doi:10.1089/dis.2007.0021
40.
MoranKBursonRCritchettJOllaP. Exploring the cost and clinical outcomes of integrating the registered nurse–certified diabetes educator into the patient-centered medical home. Diabetes Educ. 2011;37(6):780-793. doi:10.1177/0145721711423979
41.
HuangSJGalárragaOSmithKAFuimaonoSMcGarveyST. Cost-effectiveness analysis of a cluster-randomized, culturally tailored, community health worker home-visiting diabetes intervention versus standard care in American Samoa. Hum Resour Health. 2019;17(1):17. doi:10.1186/s12960-019-0356-6
42.
KraemerDFKradjanWABiancoTMLowJA. A randomized study to assess the impact of pharmacist counseling of employer-based health plan beneficiaries with diabetes: the EMPOWER study. J Pharm Pract. 2012;25(2):169-179. doi:10.1177/0897190011418513
LorigKRitterPLVillaFPietteJD. Spanish diabetes self-management with and without automated telephone reinforcement: two randomized trials. Diabetes Care. 2008;31(3):408-414. doi:10.2337/dc07-1313
45.
TaveiraTHDooleyAGCohenLBKhatanaSAMWuW-C. Pharmacist-led group medical appointments for the management of type 2 diabetes with comorbid depression in older adults. Ann Pharmacother. 2011;45(11):1346-1355. doi:10.1345/aph.1Q212
46.
WolfAMSiadatyMYaegerB, et al. Effects of lifestyle intervention on health care costs: Improving Control with Activity and Nutrition (ICAN). J Am Diet Assoc. 2007;107(8):1365-1373. doi:10.1016/j.jada.2007.05.015
47.
WuW-CTaveiraTHJefferyS, et al. Costs and effectiveness of pharmacist-led group medical visits for type-2 diabetes: a multi-center randomized controlled trial. PLoS One. 2018;13(4): e0195898. doi:10.1371/journal.pone.0195898
48.
HamidSDunsigerSSeidenA, et al. Impact of a diabetes control and management intervention on health care utilization in American Samoa. Chronic Illn. 2014;10(2):122-134. doi:10.1177/ 1742395313502367
49.
ReinhardtUE. The pricing of U.S. hospital services: chaos behind a veil of secrecy. Health Aff (Millwood). 2006;25(1):57-69. doi:10.1377/hlthaff.25.1.57
50.
PhilipsZGinnellyLSculpherM, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess. 2004;8(36):iii-iv, ix-xi, 1-158. doi:10.3310/hta8360
51.
FranklinBEFarlandMZThomasJMcFarlandMSRaySMByrdDC. Pharmacoeconomic analysis of the diabetes initiative program: a pharmacist-physician collaborative care model. Ann Pharmacother. 2013;47(12):1627-1634. doi:10.1177/1060028 013506883
52.
SchechterCBCohenHWShmuklerCWalkerEA. Intervention costs and cost-effectiveness of a successful telephonic intervention to promote diabetes control. Diabetes Care. 2012;35(11):2156-2160. doi:10.2337/dc12-0048
53.
RamseySWillkeRBriggsA, et al. Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA Task Force report. Value Health. 8(5):521-523. doi:10.1111/j.1524-4733.2005.00045.x
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
