Effective diabetes complication management is a step toward a carbon-efficient planet: an economic modeling study

Abstract

Background: The management of diabetes-related complications accounts for a large share of total carbon dioxide equivalent (CO₂e) emissions. We assessed whether improving diabetes control in people with type 2 diabetes reduces CO₂e emissions, compared with those with unchanging glycemic control.

Methods: Using the IQVIA Core Diabetes Model, we estimated the impact of maintaining glycated hemoglobin (HbA_1c) at 7% (53 mmol/mol) or reducing it by 1% (11 mmol/mol) on total CO₂e/patient and CO₂e/life-year (LY). Two different cohorts were investigated: those on first-line medical therapy (cohort 1) and those on third-line therapy (cohort 2). CO₂e was estimated using cost inputs converted to carbon inputs using the UK National Health Service's carbon intensity factor. The model was run over a 50-year time horizon, discounting total costs and quality adjusted life years (QALYs) up to 5% and CO₂e at 0%.

Results: Maintaining HbA_1c at 7% (53 mmol/mol) reduced total CO₂e/patient by 18% (1546 kgCO₂e/patient) vs 13% (937 kgCO₂e/patient) in cohorts 1 and 2, respectively, and led to a reduction in CO₂e/LY gain of 15%-20%. Reducing HbA_1c by 1% (11 mmol/mol) caused a 12% (cohort 1) and 9% (cohort 2) reduction in CO₂e/patient with a CO₂e/LY gain reduction of 11%-14%.

Conclusions: When comparing people with untreated diabetes, maintaining glycemic control at 7% (53 mmol/mol) on a single agent or improving HbA_1c by 1% (11 mmol/mol) by the addition of more glucose-lowering treatment was associated with a reduction in carbon emissions.

Keywords: cost effectiveness; economic impact; environmental factors; type 2 diabetes.

Figure 1

Reduction in total carbon emission per patient. CO₂e, carbon dioxide equivalent.

Figure 2

Factors responsible for reduction in total carbon emission per patient. *Components of management-related carbon emission include concomitant medication (statins, ACE inhibitors, and so on), screening, and patient management and preventive programs. CVD, cardiovascular disease; kgCO₂e, carbon dioxide equivalent.

Figure 3

Reduction in total carbon emission per patient as calculated with inputs from systematic literature review only. Baseline: results obtained when the respective cohorts were treated with the comparator (placebo/no therapy); scenario 1: HbA_1c concentration maintained at 7% (53 mmol/mol) throughout model simulation; scenario 2: HbA_1c permanently reduced by 1% (11 mmol/mol) point from baseline; cohort 1: patients on first-line therapy; cohort 2: patients on third-line therapy. CO₂e, carbon dioxide equivalent; HbA_1c, glycated hemoglobin.

Figure 4

Factors responsible for reduction in total carbon emission per patient as calculated with inputs from systematic literature review only. *Components of management-related carbon emission include concomitant medication (statins, ACE inhibitors, and so on), screening, and patient management and preventive programs. Baseline: results obtained when the respective cohorts were treated with the comparator (placebo/no therapy); scenario 1: HbA_1c concentration maintained at 7% (53 mmol/mol) throughout model simulation; scenario 2: HbA_1c permanently reduced by 1% (11 mmol/mol) point from baseline; cohort 1: patients on first-line therapy; cohort 2: patients on third-line therapy. CVD, cardiovascular disease; HbA_1c, glycated hemoglobin; kgCO₂e, carbon dioxide equivalent.