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

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

Diabetes-related health care costs at baseline and follow-up in type 2 diabetes patients with and without C/E in PSM analyses. *P < 0.0001, †P = 0.0002.
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Figure 1: Diabetes-related health care costs at baseline and follow-up in type 2 diabetes patients with and without C/E in PSM analyses. *P < 0.0001, †P = 0.0002.

Mentions: During the baseline period, total (all-cause) health care costs among propensity score–matched patients who received C/E were similar to those without C/E. (Health care costs [mean ± SD] at baseline were characteristics of the basis on which patients were matched: C/E group, $20,076 ± $53,741; non-C/E group, $22,432 ± $45,030; P = 0.14). At the end of the 1-year follow-up period, total health care costs (mean ± SD) were higher for patients with C/E ($24,747 ± $57,670) compared to the total costs for those without C/E ($18,378 ± $37,522; P < 0.001). Diabetes-related charges (mean ± SD) at baseline and 1-year follow-up were lower for matched patients who received C/E (Figure 1).


Real-World Evaluation of the Effects of Counseling and Education in Diabetes Management
Diabetes-related health care costs at baseline and follow-up in type 2 diabetes patients with and without C/E in PSM analyses. *P < 0.0001, †P = 0.0002.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4231931&req=5

Figure 1: Diabetes-related health care costs at baseline and follow-up in type 2 diabetes patients with and without C/E in PSM analyses. *P < 0.0001, †P = 0.0002.
Mentions: During the baseline period, total (all-cause) health care costs among propensity score–matched patients who received C/E were similar to those without C/E. (Health care costs [mean ± SD] at baseline were characteristics of the basis on which patients were matched: C/E group, $20,076 ± $53,741; non-C/E group, $22,432 ± $45,030; P = 0.14). At the end of the 1-year follow-up period, total health care costs (mean ± SD) were higher for patients with C/E ($24,747 ± $57,670) compared to the total costs for those without C/E ($18,378 ± $37,522; P < 0.001). Diabetes-related charges (mean ± SD) at baseline and 1-year follow-up were lower for matched patients who received C/E (Figure 1).

View Article: PubMed Central - PubMed

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&ndash;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&rsquo; pre-index and 12 months&rsquo; 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.

No MeSH data available.


Related in: MedlinePlus