Real-World Evaluation of the Effects of Counseling and Education in Diabetes Management
Open accessAbstract
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.
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The real rate of hypoglycaemia is probably higher than the observed 9.1% because events not captured in claims data were not included, so the incidence is underreported.
“The real rate of hypoglycaemia is probably even higher as hypoglycaemia events that were not captured in claims data were not included, with the result that the incidence of hypoglycaemia is underreported.19,25”
From Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes (2019) · cites this paper as [25]
Claims data are often inherently prone to underrepresenting hypoglycaemia as only ICD-9-CM/ICD-10-CM codes associated with a healthcare encounter are captured.
“Furthermore, claims data are often inherently prone to underrepresenting hypoglycaemia as only ICD-9-CM/ICD-10-CM codes associated with a healthcare encounter are captured.19,25,31”
From Early hypoglycaemia and adherence after basal insulin initiation in a nationally representative sample of Medicare beneficiaries with type 2 diabetes (2019) · cites this paper as [25]
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- Authors
- Dalal, M. R., Robinson, S. B., & Sullivan, S. D.
- Affiliations
- University of Washington (US)
- Corresponding author
- Dalal, Mehul R.
- Venue
- Diabetes Spectrum
- Publisher
- American Diabetes Association
- Published
- 2014-11-01
- Volume
- 27
- Issue
- 4
- Pages
- 235-243
- ISSN
- 1040-9165 (ISSN-L)
- 1944-7353
- PMC
- PMC4231931
- OpenAlex
- W2144668004
- Cited by
- 18
- References
- 36
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 3 · 2021: 1 · 2020: 2 · 2019: 4 · 2018: 1 · 2017: 1 · 2016: 2
- FWCI
- 0.80
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Diabetes Spectrum (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association
- Sanofi
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes counseling, patient education, type 2 diabetes, health care costs, glycemic control, hypoglycemia, cost-effectiveness, health insurance coverage
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