Long-term effectiveness of a disease management program to prevent diabetic nephropathy: a propensity score matching analysis using administrative data in Japan

Abstract

Background Existing reviews indicated that disease management for patients with diabetes may be effective in achieving better health outcomes with less resource utilization in the short term. However, the long-term results were inconsistent because of the heterogeneous nature of the study designs. In the present study, we evaluated the 5-year follow-up results of a local disease management program focused on diabetic nephropathy prevention under the universal public health insurance scheme in Japan. Methods Patients diagnosed with type 2 diabetes who had stage 3 or 4 diabetic kidney disease and were aged between 20 and 75 years were invited to join a disease management program to support self-management and receive a recommended treatment protocol between 2011 and 2013. Follow-up data were collected from an electronic claims database for the public insurance scheme. Considering the non-random selection process, we prepared two control groups matched by estimated propensity scores to compare the incidence of diabetes-related complications, death, and resource utilization. Results The treatment group was more likely to receive clinical management in accordance with the guideline-recommended medication. After propensity score matching, the treatment group had lower incidence of diabetic nephropathy and emergency care use than the control group selected from a beneficiary pool mainly under primary care. Comparisons between the treatment group and the control group with more selected clinical conditions did not show differences in the incidence rate and resource utilization. Conclusions The present results demonstrated limited effectiveness of the program for reducing complication incidence and resource utilization during the 5-year follow-up. Further research on the long-term effectiveness of co-management by primary care physicians, subspecialists in endocrinology and nephrology, and nurse educators is required for effective management of diabetes-related nephropathy.

Reduction in all-cause medical and caregiving costs through innovative health awareness projects in a rural area in Japan: a retrospective cohort study

“…Public medical insurance providers, including local governments, who provide enrolees with the opportunity to opt-out (passive consent), are able to utilize anonymized data without data linkage in collaboration with academic and research organizations, solely for getting valuable information to maintain and improve enrolees’ wellness [ 26 ]. Under this process, the limited long-term effect of a local government health program on medical cost reduction was reported [ 26 ]. The nationwide SHC program has been required to be offered by law since 2008, but a recent report indicated that it had no effect on improving or maintaining laboratory values [ 10 ].…”

Chronic disease management program applied to type 2 diabetes patients and prevention of diabetic complications: a retrospective cohort study using nationwide data

“…This finding is supported by the higher frequency of outpatient visits among CDMP participants. Under Japan's universal public health insurance system, a five-year follow-up of local disease management programs, including patient education programs with a focus on preventing diabetic complications, showed that these programs were somewhat effective in reducing diabetic complications and the need for emergency care [ 27 ]. In a retrospective chart review conducted in the United States and published in 2022, the effects of comprehensive diabetes education on the reduction of glycated hemoglobin (HbA1c) and fasting blood glucose were reported [ 8 ].…”