Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 20;22(1):135.
doi: 10.1186/s12902-022-01040-4.

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

Hirohito Watanabe  1   2 , Hisataka Anezaki  3 , Kana Kazawa  1 , Yuya Tamaki  1 , Hideki Hashimoto  3 , Michiko Moriyama  4
Affiliations

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

Hirohito Watanabe et al. BMC Endocr Disord. .

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.

Keywords: Diabetic nephropathy; Disease management; Electronic claims database; Health outcomes; Self-management.

PubMed Disclaimer

Conflict of interest statement

The self-management program evaluated in the current study was provided by DPP Health Partners, Co. Ltd. under the contraction with Kure City authority, invested by Data Horizon, Co. Ltd., RCC Broadcasting, Co. Ltd., and MM when started. The original version of the program was developed by KK and MM as a part of thesis research of KK. The program was afterward adopted and modified by DPP Health Partners, Co. Ltd. MM was a non-corporate executive officer for the company between December 2010 and October 2018, supporting the in-house training for staff nurses unrelated to the self-management implementation, with stock share that was declared and approved by Hiroshima University authority for conflict-of-interests management. Since November 2018, MM abandoned the stock share, and has no conflict of interests with the company. The anonymized data used in the current study was provided by Kure City National Health Insurance authority for independent evaluation of the program effectiveness. Otherwise, authors have no conflict of interests to be declared.

Figures

Fig. 1
Fig. 1
Flow chart for selection of the study subjects. Note: The number of samples and patients are described by person-years, as matching was done by multiple years
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. International Diabetes Federation . IDF Diabetes Atlas. 9. Brussels, Belgium: International Diabetes Federation; 2019. - PubMed
    1. van Dieren S, Beulens JW, van der Schouw YT, Grobbee DE, Neal B. The global burden of diabetes and its complications: an emerging pandemic. Eur J Cardiovasc Prev Rehabil. 2010;17(Suppl 1):S3–8. doi: 10.1097/01.hjr.0000368191.86614.5a. - DOI - PubMed
    1. Cannon A, Handelsman Y, Heile M, Shannon M. Burden of illness in type 2 diabetes mellitus. J Manag Care Spec Pharm. 2018;24(9-a Suppl):s5–13. doi: 10.18553/jmcp.2018.24.9-a.s5. - DOI - PMC - PubMed
    1. Pugliese G, Penno G, Natali A. Diabetic kidney disease: new clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on “The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function”. J Nephrol. 2020;33(1):9–35. doi: 10.1007/s40620-019-00650-x. - DOI - PMC - PubMed
    1. Tziomalos K, Athyros VG. Diabetic nephropathy: new risk factors and improvements in diagnosis. Rev Diabet Stud. 2015;12(1–2):110–118. doi: 10.1900/RDS.2015.12.110. - DOI - PMC - PubMed