A disease management program focused on diabetic nephropathy prevention in Kure City, Japan saw patients more likely to receive appropriate clinical management and medication than a control group, research published in BMC Endocrine Disorders shows. However, after propensity score matching, the researchers found the program had only a limited effect on reducing incidence of complications, such as diabetic retinopathy.
The longitudinal 5-year follow-up study reviewed participants (aged 20-75 years) diagnosed with type 2 diabetes who were enrolled in a 6-week program which offered self-management education.
The research included data from 153 participants, and 2 groups of control participants consisting of 2635 participants (Control Group 1), and 11,806 participants (Control Group 2). Control group 1 was made up of screened candidates for the program, while control group 2 were other beneficiaries of Japan’s universal health care program who met study inclusion criteria. Researchers documented the occurrence of macroangiopathy and microangiopathy (including diabetic retinopathy requiring surgery), hospitalizations, emergency care use, deaths, and dependency in daily activities (toileting, bathing, clothing and eating).
Results show significant differences between control group 2 and the treatment group in diabetes-related complications (20.4% vs. 12.9%, P <.05), nephropathy requiring hemodialysis (4.3% vs. 0.7%, P <.05), and emergency care use (25.5% vs. 15.1%, P <.01).
The 5-year follow-up shows 4.3% of the patients in the treatment group experienced diabetic retinopathy requiring surgery. That’s compared with 5.1% in control group 1 and 6.3% in control group 2.
The cost of intervention for the treatment group was $34,836 USD (90% CI, 29,865–39,807 USD), while the cost for control group 1 was 37,758 USD (90% CI: 34,354–41,161) and control group 2 was 45,336 USD (90% CI: 41,152–49,519 USD).
Overall, researchers report that the program has shown limited effects when compared with controls.
The limitations of this study include the nonrandomized design, lack of consideration for socioeconomic factors of each patient, the small sample size, and missing laboratory data, which could each impact the results.
Watanabe H, Anezaki H, Kazawa K, Tamaki Y, Hashimoto H, and Mariyama M. Long-term effectiveness of a disease management program to prevent diabetic nephropathy: a propensity score matching analysis using administrative data in Japan. BMC Endocrine Disorders. 2022;22:135. doi:10.1186/S12902-022-01040-4