The value of guideline-recommended management of type 2 diabetes: a novel population-level system dynamics approach
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This study estimated the system-level impact of adopting a holistic approach to T2D management in-line with contemporary international guidelines.
Abstract: Traditionally, the focus of diabetes treatment in the UK has been glucose management (GM); however, international guidelines increasingly recommend a holistic approach (HA), considering comorbidities and cardiovascular (CV) risk. We developed a novel age- and disease-stratified population-level system dynamics model that predicts the prevalence of T2D and the burden of T2D-associated complications in the UK setting. The model was calibrated against ONS population estimates and T2D prevalence data from the National Diabetes Audit for 2001–2020 and the rates of fatal and non-fatal complications were sourced from the UK Prospective Diabetes Study (UKPDS). The GM scenario represents limited use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), as observed in the model calibration period. The HA scenario represents proactive disease management with emphasis on cardiorenal protection, and corresponding increased use of GLP-1 RAs. Applying the HA is predicted to decrease the annual incidence of CV complications from 46.16 to 42.11 per 1,000 patients in 2040 when compared to the GM approach, resulting in 9,560 fewer hospitalisations, 74,140 fewer bed days, and 3,850 deaths avoided annually. Cumulatively (2023-2040), applying the HA resulted in reductions in the burden of T2D complications; 72k deaths avoided, 1.32m fewer bed days, 81m tonnes of water saved, 2.2m more productive work days, and £1.7bn saved in healthcare costs. HA has the potential to deliver substantial savings in the health, social and personal burden of diabetes-associated complications, with the potential for increased savings when wider costs are considered.
Lay abstract: This study looked at how managing type 2 diabetes (T2D) in line with current international guidelines could impact health and costs in the UK. Traditionally, diabetes treatment focused mainly on controlling blood sugar. However, new guidelines suggest a more comprehensive approach, taking into account other health issues such as heart and kidney complications. Adoption of the new guidelines was predicted to reduce deaths by 72,000, reduce hospital bed days by 1.32m, and reduce healthcare costs by £1.7bn (all between 2023 and 2040).
This work was paid for by Novo Nordisk A/S.
Recommended citation: McEwan, P., Padgett, T., Goulden, S., Chubb, B., Mansinho, J., Hongye, R. (2024) The value of guideline-recommended management of type 2 diabetes: a novel population-level system dynamics approach. Diabetes 14 June 2024; 73 (Supplement_1): 1040–P. https://doi.org/10.2337/db24-1040-P