title: Cost and benefits of a multidisciplinary intensive diabetes education programme.
abstract: OBJECTIVE
  To determine the cost and benefits of an intensive diabetes education programme for patients with prolonged self-management problems and to determine the inclusion criteria for optimal outcomes.
  
  
  METHODS
  Sixty-one participants of a multidisciplinary intensive diabetes education programme (MIDEP) were measured before they started the intervention (T0), and at 1-year follow-up (T1). Data on glycaemic control (HbA1c), diabetes-related distress (PAID) and costs were obtained. Changes over time were analysed and means at T0 and T1 were compared to a reference group of 230 non-referred consecutive outpatients. The number needed to treat (NNT), that is, the number of patients to be treated to achieve one successful case, was calculated for different baseline values of HbA1c and PAID to determine optimal inclusion criteria.
  
  
  RESULTS
  Diabetes-related costs decreased significantly and participants improved significantly in HbA1c and diabetes-related distress following MIDEP. HbA1c and distress reached the levels of the reference group. The T1 costs remained higher than in the reference group, but the reduction in costs outweighed the intervention costs. Including patients with baseline HbA1c>or=8.0% and/or PAID scores>or=40 would improve the NNT to achieve clinically relevant outcomes, while 76% of the patients matched these inclusion criteria.
  
  
  CONCLUSIONS
  MIDEP is effective in improving glycaemic control and diabetes-related distress for patients with prolonged self-management difficulties. Besides the immediate reduction in costs found in the present study, improved glycaemic control may reduce future costs of diabetic complications. Stricter inclusion criteria with respect to HbA1c and PAID scores may further improve the programme's efficiency.
authors.affiliation: Northern Centre for Healthcare Research, University of Groningen, the Netherlands. j.c.keers@int.azg.nl
authors.forename: J C
authors.initials: JC
authors.lastname: Keers
authors.forename: H
authors.initials: H
authors.lastname: Groen
authors.forename: W J
authors.initials: WJ
authors.lastname: Sluiter
authors.forename: J
authors.initials: J
authors.lastname: Bouma
authors.forename: T P
authors.initials: TP
authors.lastname: Links
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000097:blood / Q000191:economics* / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D017048:Health Care Costs; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic / Q000191:economics* / Q000379:methods; D018579:Patient Selection; D016730:Program Development; D015397:Program Evaluation; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin