gms | German Medical Science

Background and status of research: Findings about the effectiveness of disease management programs (DMPs) in the treatment of diabetes are inconsistent. A systematic review from Germany found that DMPs can have positive effects on process parameters and certain outcome parameters (e.g. mortality and survival time) of diabetes treatment, while no conclusion could be drawn for the economic parameters (direct costs, cost effectiveness) [1]. A meta-analysis on the effects of European chronic care programs for type 2 diabetes reported small effects on outcome parameters (e.g. level of HbA1c) in screen-detected and newly diagnosed, but not in prevalent diabetes [2].

Question and objective: Our aim was to evaluate the impact of a DMP for patients with diabetes type 1 or 2 on guideline-concordant care, hospitalization risk and health care costs in a Swiss primary care setting.

Method: In a prospective observational study, we compared diabetes patients in a DMP (intervention group; N=530) with diabetes patients receiving usual care (control group; N=5050) using propensity score kernel matching with entropy balancing as a statistical control strategy. We used a difference-in-difference (DiD) approach and compared changes in outcomes from baseline to two-year follow-up (2017–2019) between the groups. Outcomes included four measures for guideline-concordant diabetes care (screening for nephropathy or intake of ACE inhibitors, lipid profile, at least two annual measurements of HbA1c or continuous glucose monitoring, control at ophthalmologist every two years), hospitalizations and health care costs.

Results: We identified a positive impact of the DMP on the percentage of patients fulfilling all criteria for guideline-concordant care (DiD +8%-points [95%CI: 4%-points,12%-points]): screening for nephropathy or intake of ACE inhibitors (DiD +8%-points [95%CI: 3%-points,12%-points]) and ophthalmologic controls (DiD +6%-points [95%CI: 1%-point,11%-points]) were performed significantly more often in the DMG group compared to the controls. Also, the hospitalization rate (DiD -4%-points [95%CI: -8.5%-points,0.7%-points]) and the health care costs (CHF -908.7/approx. Euro -820 [95%CI: CHF -2089.2, CHF 271.7]) showed a more favorable development in the intervention group compared to the control group, but these differences were not statistically significant.

Discussion: After two years, this DMP for diabetes patients positively influenced treatment quality and simultaneously lowered costs and reduced the hospitalization risk.

Practical implications: Patients with diabetes in a DMP can benefit from better treatment quality at potentially lower costs.

Appeal for practice/science in one sentence: This DMP showed positive effects on diabetes care quality in a primary care setting, but further studies with a longer follow-up are needed to evaluate its long-term effects.