Economic Outcomes and Health Care Utilization of DSMES Interventions: A Systematic Review and Recommendations for Research

Value-driven outcomes are important, especially when health systems are determining sustainability of Diabetes Self-Management Education & Support (DSMES). We conducted a systematic review to synthesize existing research of the economic outcomes and healthcare utilization for interventions that incorporate DSMES in the US. Seven databases were searched for relevant published studies that included of at least one component of the Association of Diabetes Care and Education Specialists 7 Self-Care Behaviors (ADCES7). Reviewers independently selected articles, extracted data and assessed the methodological quality of included studies. In total, 14,804 records were identified, 25 articles met the inclusion criteria. Three articles were determined to have poor quality and were not included in the final analysis. Our findings are based on a total of 22 articles describing 21 studies. DSMES interventions varied widely, including face-to-face education, group classes, home visits with community health workers, telemedicine visits, education modules, and/or visits with registered dietitians, nurses and/or pharmacists. A majority of the studies were not specifically designed for health economic evaluation. Seven studies reported a statistically significant decrease in either total health care costs, hospital or emergency utilization, outpatient medical costs, and/or medication costs. Four of the seven studies utilized all components of the ADCES7. Clinical impact across studies varied. Studies that measured HbA1c found a decrease over their study time frame. The methodological heterogeneity among studies was considerable; therefore, a meta-analysis was not conducted. Our review highlights DSMES interventions may positively impact economic outcomes and/or healthcare utilization, though not all studies showed consistent benefit. This review highlights an evidence gap and future full health economic evaluations are warranted. Disclosure C. Whitehouse: None. A. Bzowyckyj: None. S. B. Srivastava: None. A. I. Kauwe tuitama: None. J. E. Blanchette: Board Member; Self; JDRF, Consultant; Self; Insulet Corporation, Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care, Research Support; Self; Association of Diabetes Care and Education Specialists. S. A. Haydon-greatting: None. V. J. Brady: None. T. Smith: None. M. L. Litchman: Research Support; Self; Abbott Diabetes. K. E. Yehl: None.