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Effect of Education, Counseling on Diabetes Care

Authors

Tim Casey

San Diego—A retrospective analysis of medical insurance claims data found patients with diabetes who received education and counseling were more likely to have glycemic control and lower diabetes-related healthcare charges compared with those not receiving education or counseling. However, the authors said that only 9.3% of patients in the managed care setting had an education or counseling intervention. The results were presented at the ADA meeting in a poster titled A Real-World Evaluation of the Effects of Education and Counseling on Diabetes Care. According to the researchers, 25.8 million people in the United States had diabetes in 2010, an increase of approximately 50% in 3 years. Approximately 90% to 95% of diabetic patients have type 2 diabetes. They cited data from the ADA that the total medical cost associated with diabetes was $174 billion in 2007. To evaluate the role that education and counseling have on patients, the authors utilized data from the Premier-i3 Continuum of Care database, which contained information about hospitalizations and care before and after hospitalization. Patients were included in the study if they were ≥18 years of age, had type 2 diabetes, had ≥1 inpatient claim or ≥2 outpatient visits dated ≥30 days apart, and had ≥1 clinic visit between July 1, 2005, and June 30, 2009. In addition, patients had to have continuous medical and pharmacy coverage for ≥6 months before the index date and ≥12 months after the index date. Of the 26,790 patients in the trial, 2490 had ≥1 claim for a diabetes-related visit and associated education and counseling interventions. Of the 2490 patients, 73.2% received diabetes education, 21.0% had nutrition and diet counseling, and 4.7% received health education not specific for diabetes (control group). In the education and counseling group, the mean age was 53.0 years, 46.8% were men, and the mean Charlson Comorbidity Index (CCI) score was 1.4. In the control group, the mean age was 56.7 years, 54.2% were men, and the mean CCI score was 2.3. To eliminate selection bias, the authors used propensity score matching in a 1:1 ratio to match patients who received education and counseling with those who did not receive education or counseling. Each of the groups included 1890 patients and had an approximately similar proportion of men and women. In the unmatched analysis, the mean hemoglobin A1c (HbA1c) level after 12 months was 6.7% in patients receiving education and counseling compared with 7.5% in those not receiving education or counseling (P<.0029). Patients in the education and counseling group were also >4 times more likely to have an HbA1c level <7.0% (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.4-15.3). There was no significant difference between the groups in terms of hypoglycemia incidence (P=.8168). In the matched analysis, the mean HbA1c level after 12 months was 6.7% in the education and counseling group compared with 7.5% in the control group (P=.0156). Patients in the education and counseling group were also >4 times more likely to have an HbA1c level <7.0% (OR, 4.60; 95% CI, 0.9-24.0). There was no significant difference between the groups in terms of hypoglycemia incidence (P=.3734). After 12 months, the healthcare charges were similar in the unmatched analysis ($22,531 in the education and counseling group vs $22,121 in the control group; P=.689). However, there was a statistically significant difference in diabetes-related costs ($5313 vs $11,448; P<.0001). The 12-month healthcare charges in the matched analysis were significantly higher for patients who received education and counseling ($24,747 vs $18,378; P<.0001), although the diabetes-related charges were significantly lower in the education and counseling group ($6795 vs $9130; P=.0002). The authors cited a few limitations. Because the trial analyzed claims data, there may have been coding errors or limited availability of clinical data. In addition, the data may not be representative of the US population. Furthermore, not all insurers reimburse education and counseling services and/or patients may not be aware of the services. This study was funded by sanofi-aventis US, Inc.

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