GlobalData PLC, New York, New York.
Omada Health Inc., San Francisco, California.
Sci Diabetes Self Manag Care. 2022 Aug;48(4):258-269. doi: 10.1177/26350106221100779. Epub 2022 Jun 4.
To analyze economic savings and health impacts associated with a virtual digitally enhanced diabetes self-management education and support (DSMES) program.
Participants (n = 1,494) were nonpregnant adults with diagnosed type 2 diabetes and baseline body mass index (BMI) of 25 kg/m (23 kg/m if of Asian descent) or higher who enrolled in virtual DSMES between February 2019 and April 2020 for at least 4 months. Participants' changes in glycated hemoglobin (A1C) and body weight were calculated as the difference between program start and last recorded values between months 4 and 6. Outcomes for all participants were analyzed; subanalyses were done on 628 participants with starting A1C >7% (53 mmol/mol), who could benefit most from DSMES. Markov-based microsimulation approach was used to model the potential reductions in diabetes sequalae and medical expenditures if observed improvements in A1C and BMI were maintained.
DSMES participants with starting A1C >7% experienced average reductions of 0.9% A1C and 2.1 kg of body weight (-1.7% of BMI) within 6 months. If these improvements were maintained, simulated outcomes include reduced 5-year onset of ischemic heart disease by 9.2%, myocardial infarction by 10.6%, stroke by 12.1%, chronic kidney disease by 16.5%, and reduced onset of other sequelae. Simulated cumulative reduction in medical expenditures is $1160 after 1 year, $4150 after 3 years, $7790 after 5 years, and $18 020 after 10 years.
Participation in virtual DSMES improves A1C and body weight, with the potential to slow onset of diabetes sequelae and reduce medical expenditures.
分析虚拟数字化强化糖尿病自我管理教育和支持（DSMES）项目带来的经济节省和健康影响。
参与者（n=1494）为患有 2 型糖尿病且基线体重指数（BMI）≥25kg/m²（亚裔参与者为 BMI≥23kg/m²）的非妊娠成年人，他们在 2019 年 2 月至 2020 年 4 月期间参加了至少 4 个月的虚拟 DSMES。参与者的糖化血红蛋白（A1C）和体重变化是通过计算程序启动和 4 至 6 个月之间最后记录的数值之间的差值得出的。对所有参与者的结果进行了分析；对 628 名 A1C 起始值＞7%（53mmol/mol）的参与者进行了亚组分析，这些参与者最能从 DSMES 中受益。采用基于马尔可夫的微模拟方法来模拟如果观察到的 A1C 和 BMI 改善得以维持，糖尿病并发症和医疗支出的潜在减少。
A1C 起始值＞7%的 DSMES 参与者在 6 个月内平均降低了 0.9%A1C 和 2.1kg 体重（BMI 降低 1.7%）。如果这些改善得以维持，模拟结果包括 5 年内缺血性心脏病发病减少 9.2%、心肌梗死减少 10.6%、中风减少 12.1%、慢性肾脏病减少 16.5%以及其他并发症发病减少。模拟累积医疗支出在 1 年内减少 1160 美元，3 年内减少 4150 美元，5 年内减少 7790 美元，10 年内减少 18020 美元。
参加虚拟 DSMES 可改善 A1C 和体重，有潜力减缓糖尿病并发症的发生并降低医疗支出。
