Type 2 diabetes (T2D) treatment involves complex interactions among biological, psychological, and behavioral factors of care. The treatment requires multifaceted efforts in clinical practice and disease management to reduce health and economic burdens. Cobden and colleagues sought to quantify correlations among these factors and characterize their level of inclusion in economic analyzes that are part of informed medical decision-making. A comprehensive, stepwise systematic literature review was performed on published articles dated 1993 to 2008 using medical subject heading and keyword searches in electronic reference libraries. Data were collected using standardized techniques and were analyzed descriptively. A total of 97 articles fulfilling all inclusion criteria were reviewed, including 16 on economic models (17% of articles). Most studies were retrospective (41 of 97 or 42%) and from managed care perspectives (66%). Oral anti-diabetic drugs were a central focus, appearing in 83% of studies. Patient behaviors, particularly medication adherence and persistence in real-world settings, are well researched (n = 65) and may influence diabetes outcomes, cardiovascular risk, mortality rates, and treatment-specific resource use (e.g., hospitalizations) and costs (

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER. The authors concluded that strong correlations exist between patient behaviors, perspectives of care, health outcomes, and costs in T2D. Enhancing their inclusion in pharmacoeconomic modeling, notably the influence on clinical effectiveness of variation in self-management between treatments, should lead to more accurate estimates of comparative cost-effectiveness, and thereby improve value-based resource allocation and patient access to appropriate therapy.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The exclusion of the variables noted by the authors, particularly medication adherence, should not be omitted to any economic model of any chronic illness. These factors, in the long run, are as important as any other economic variables, including the costs of medications, used to estimate the costs of chronic conditions.

DS Cobden et al. Relationships among Self-Management, Patient Perceptions of Care, and Health Economic Outcomes for Decision-Making and Clinical Practice in Type 2 Diabetes. Value Health, August 20, 2009.