Connecting Lifestyle Modifications to HCRU, Costs in Patients With Diabetes Mellitus

Researchers examined the characteristics of patients with diabetes mellitus who incorporated non-pharmacological therapies into their lifestyle and the relationship between these therapies and health care resource utilization (HCRU) and spending. Patients who did not adopt nonpharmacological interventions had higher HCRU and medication usage compared to those who did, according to findings published in the Saudi Pharmaceutical Journal. 

Diabetes mellitus is a chronic metabolic disease that affects over 537 million people worldwide, including approximately 37.3 million Americans, costing the United States around $294.6 billion. Adopting lifestyle changes such as exercise and a healthy diet can both prevent and effectively manage diabetes and lead to improved health outcomes, said researchers. 

A retrospective observational database analysis was conducted using Medical Expenditure Panel Survey (MEPS) data from families, individuals, medical providers, and employers across the United States. The independent variable in this study was a non-pharmacological intervention, specifically dual interventions consisting of diet modification and physical activity. Physical activity was defined as moderate-to-vigorous exercise at least 5 times per week and diet modification as healthy eating to manage and treat diabetes. 

Variables including age, sex, race/ethnicity, and insurance status, were considered to avoid overestimation or underestimation of the intervention effect. The outcome variables of health care utilization and expenditure were collected through the MEPS household data. Expenditure was defined as the sum of direct payments for health care services, while utilization data were organized into categories such as office-based, hospital outpatient, emergency department, inpatient department, and prescribed medicine. 

Chi square tests and generalized linear models were used to analyze the data and assess the true intervention effects. Additionally, a subanalysis using propensity score matching (PSM) was conducted to compare the differences between the two modes of non-pharmacological intervention, aiming to reduce selection bias and confounding.
Of 26.4 million adults aged 18 years or older that reported having diabetes mellitus, around 81% used at least one nonpharmacological intervention. Only 4.8 million patients with diabetes did not integrate any non-pharmacological intervention into their therapy regimen. A higher percentage of patients with diabetes used both modes of non-pharmacological interventions, with female patients more likely to use a single mode. Caucasians were the majority race/ethnicity group in all intervention groups, while Hispanics accounted for 16.4% and 17.8% of the dual and single intervention groups respectively.

Patients with a higher socioeconomic status were more likely to follow at least one non-pharmacological intervention compared to those with poor economic status. However, there were no significant differences in family income between the groups. Most patients with diabetes had education beyond high school. A significant interaction was found when comparing the types of lifestyle modifications based on education completed by the respondents.

Patients who engaged in physical activity and diet modification used office-based care more often and had fewer prescriptions compared to their counterparts. There were no significant differences in the total number of inpatient visits between the groups, but outpatient department utilization was significantly different. Patients who adhered to healthy lifestyles used emergency room services less frequently. The generalized linear model test did not find any significant differences between the groups.

In terms of health care utilization, patients who relied solely on physical activity had fewer prescribed medicines and office-based visits compared to those who relied solely on diet modifications. However, the costs associated with these utilization categories differed. The physical activity group spent less on prescribed medicines, while the diet modification group spent less on office-based visits. Hospital stay and outpatient costs were significantly lower for patients who managed their diabetes with a healthy diet.
Those who did not include non-pharmacological interventions had higher annual total health care expenditures (M=$18,428) than those who incorporated either single (M=$17,058) or dual intervention (M=$15,134). 

The study findings indicate that a significant number of patients with diabetes did not follow recommended lifestyle interventions for managing their condition, leading to increased HCRU and costs. 

“Health care providers should consider incorporating lifestyle interventions into treatment plans for patients with diabetes to improve patient outcomes and reduce health care utilization, especially in female patients with diabetes,” said researchers. 
 

Reference: 
Alfaifi A. Association between non-pharmacological therapy and healthcare use and expenditure of patients with diabetes mellitus. Saudi Pharmaceutical Journal. 2023(31):8. doi.org/10.1016/j.jsps.2023.06.018.