Cost-Effective Interventions for Preventing, Managing Diabetes

A recent systematic review, which was presented at the 2018 78th ADA Scientific Sessions, provided critical information for making evidence-based clinical and public health policy decisions.

Although many interventions are available for preventing type 2 diabetes and also managing diabetes, their cost-effectiveness varies greatly. In order to observe the cost-effectiveness of these interventions, Karen Siegel, division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and colleagues, updated their prior systematic cost-effectiveness review of all diabetes interventions. The prior review covered studies between 1985 and 2007 and the new review covered studies from January 2008 through July 2017. 

The researchers used the same strategies to select studies, which included databases, MeSH terms and keywords, exclusion criteria, and study quality assessment tool. They grouped interventions by cost-effectiveness rations in cost per quality-adjusted life years (QALY) or life year gained. Further they used the median cost-effectiveness ratio to represent the cost-effectiveness of an intervention.

The initial search yielded 18,195 potential studies to review, which included 46 prevention and 110 management papers. 

For type 2 diabetes, the interventions that were cost-saving or very cost-effective with strong evidence included imposing taxes on sweetened beverages and structured lifestyle intervention and metformin in people at high risk. For management of diabetes and its complications, the interventions included ACE inhibitor therapy for intensive hypertension control, self-monitoring of blood glucose, comprehensive foot care to prevent ulcers, and multicomponent coordinated care with peer support for managing hypertension, hyperglycemia, hyperlipidemia, and chronic kidney disease, and early detection of diabetes complications.

“Our results provide critical information for making evidence-based clinical and public health policy decisions,” Ms Sieglel and colleagues, concluded.

—Julie Gould