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

BACKGROUND: The management of diabetes-related complications accounts for a large share of total carbon dioxide equivalent (CO(2)e) emissions. We assessed whether improving diabetes control in people with type 2 diabetes reduces CO(2)e 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 CO(2)e/patient and CO(2)e/life-year (LY). Two different cohorts were investigated: those on first-line medical therapy (cohort 1) and those on third-line therapy (cohort 2). CO(2)e 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 CO(2)e at 0%. RESULTS: Maintaining HbA(1c) at 7% (53 mmol/mol) reduced total CO(2)e/patient by 18% (1546 kgCO(2)e/patient) vs 13% (937 kgCO(2)e/patient) in cohorts 1 and 2, respectively, and led to a reduction in CO(2)e/LY gain of 15%–20%. Reducing HbA(1c) by 1% (11 mmol/mol) caused a 12% (cohort 1) and 9% (cohort 2) reduction in CO(2)e/patient with a CO(2)e/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.