Decision models of prediabetes populations: A systematic review
Open accessAbstract
Aims: With evidence supporting the use of preventive interventions for prediabetes populations and the use of novel biomarkers to stratify the risk of progression, there is a need to evaluate their cost‐effectiveness across jurisdictions. Our aim is to summarize and assess the quality and validity of decision models and model‐based economic evaluations of populations with prediabetes, to evaluate their potential use for the assessment of novel prevention strategies and to discuss the knowledge gaps, challenges and opportunities. Materials and methods: We searched Medline, Embase, EconLit and NHS EED between 2000 and 2018 for studies reporting computer simulation models of the natural history of individuals with prediabetes and/or we used decision models to evaluate the impact of treatment strategies on these populations. Data were extracted following PRISMA guidelines and assessed using modelling checklists. Two reviewers independently assessed 50% of the titles and abstracts to determine whether a full text review was needed. Of these, 10% was assessed by each reviewer to cross‐reference the decision to proceed to full review. Using a standardized form and double extraction, each of four reviewers extracted 50% of the identified studies. Results: A total of 29 published decision models that simulate prediabetes populations were identified. Studies showed large variations in the definition of prediabetes and model structure. The inclusion of complications in prediabetes (n = 8) and type 2 diabetes (n = 17) health states also varied. A minority of studies simulated annual changes in risk factors (glycaemia, HbA1c, blood pressure, BMI, lipids) as individuals progressed in the models (n = 7) and accounted for heterogeneity among individuals with prediabetes (n = 7). Conclusions: Current prediabetes decision models have considerable limitations in terms of their quality and validity and do not allow evaluation of stratified strategies using novel biomarkers, highlighting a clear need for more comprehensive prediabetes decision models.
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A reverse transition from T2D back to prediabetes was not included, to align with common practices, because this reversion is rare and unlikely to have a meaningful impact on cost-effectiveness over a lifetime horizon.
“We did not include a reverse transition from T2D back to prediabetes to be aligned with common practices in previous studies [29] as this reversion is rare and unlikely to have a meaningful impact on cost-effectiveness over a lifetime horizon.”
From Economic evaluation of wearable fitness trackers versus metformin for preventing type 2 diabetes in the UK population (2025) · cites this paper as [29]
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- Authors
- Leal, J., Morrow, L. M., Khurshid, W., Pagano, E., & Feenstra, T.
- Affiliations
- Health Economics Research Centre, Nuffield Department of Population Health University of Oxford Oxford UK
- University of Oxford (GB)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- University Medical Center Groningen (NL)
- Corresponding author
- Feenstra, Talitha
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2019-04
- Volume
- 21
- Issue
- 7
- Pages
- 1558-1569
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- PMC
- PMC6619188
- OpenAlex
- W2919856689
- Cited by
- 30
- References
- 66
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 6 · 2019: 2
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Obesity and Metabolism (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by-nc)
- Rivm Repository (Netherlands National Institute for Public Health and the Environment) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion)
- Rivm (National Institute for Public Health and the Environment) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc)
- Funders
- European Federation of Pharmaceutical Industries and Associations (16.0097)
- University of Oxford
- European Commission (HORIZON2020, 115881)
- Innovative Medicines Initiative (115881)
- Staatssekretariat für Bildung, Forschung und Innovation (16.0097)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- prediabetes, decision models, cost-effectiveness, type 2 diabetes prevention, biomarkers, risk stratification, heterogeneity, model validity, health states
- MeSH terms
- Computer Simulation, Cost-Benefit Analysis, Decision Support Techniques, Humans, Prediabetic State, Models, Statistical
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