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Abstract
Background Pre-diabetes affects one-third of adults in the USA and a subset will progress to type 2 diabetes. Our objective was to determine whether a disease-specific health plan, known as the Diabetes Health Plan (DHP), designed to improve care for persons with pre-diabetes and diabetes also led to lower rates of incident diabetes among adults with pre-diabetes.
Methods We examined eligibility and claims data from a large payer who offered the DHP to a national sample of employers. We included adult employees and dependents who were continuously covered by the DHP over a 4-year study window. The primary outcome was incident diabetes. We conducted propensity score matching at the employer level to find comparable control employer groups offering standard plans. Using an adjusted logistic regression model at the individual level, we tested the association between DHP employer group status and incident diabetes diagnosis during the 3 years of postbaseline follow-up.
Findings Our analysis included data from 11 965 continuously enrolled adults with pre-diabetes (n=1538 from nine employers offering DHP; n=10 427 from 105 control employers offering standard plans). DHP employees and covered dependents with pre-diabetes had an 8% lower absolute predicted probability of incident diabetes compared with individuals from employer groups offering standard benefit plans (29% predicted probability of incident diabetes for DHP vs 37% for controls, p<0.001).
Conclusions A pre-diabetes-specific health benefit design was associated with lower rates of incident diabetes and represents an area of needed future study.
- adult diabetes
- health policy
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Contributors All authors (1) made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, (2) drafted the article or revised it critically for important intellectual content, (3) gave final approval of the version to be published, and (4) agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Study concept and design: CMM, KD, SLE, TM, AMK, RHL, SH. Acquisition of data: RHL, AMK, CC, SH. Analysis and interpretation of data: CMM, KD, SLE, TM, JL, NT. Drafting of the manuscript: TM. Critical revision of the manuscript for important intellectual content: CMM, KD, NT, SLE. Statistical analysis: SLE, JL, NT. Obtained funding: CMM, KD. Administrative, technical, or material support: CMM, KD, CC, RHL, AMK, SH. Study supervision: CMM, KD. TM and CMM had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Funding This study was jointly funded by the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases as part of the Natural Experiments for Translation in Diabetes (NEXT-D) study (grant number DP002722). TM also receives support from Department of Veterans Affairs (QUE15-272, QUE15-286, and CSP2002). CMM receives support from the University of California at Los Angeles, Resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly under National Institutes of Health (NIH)/NIA Grant P30-AG021684, and from NIH/National Center for Advancing Translational Sciences UCLA Clinical and Translational Science Institute Grant UL1TR001881. CMM holds the Barbara A. Levey and Gerald S. Levey Endowed Chair in Medicine, which partially supported her work. KD's effort is also supported in part by the University of California, Los Angeles, Resource Center for Minority Aging Research, Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under NIH/NIA Grant P30-AG021684.
Disclaimer The findings and conclusions in this manuscript are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC) or the National Institutes of Health (NIH). CMM is a vice chairperson of the U.S. Preventive Services Task Force. This article does not represent the views and policies of the U.S. Preventive Services Task Force.
Competing interests CC, RHL, SH, and AMK are former employees of UnitedHealthcare.
Patient consent for publication Not required.
Ethics approval The study was approved by the Institutional Review Board at the University of California, Los Angeles.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data are proprietary and owned by UnitedHealthcare. Per our Data Use Agreement, we are not permitted to share any data.