OBJECTIVES

Results (n=262) from a 1-year prospective longitudinal investigation of a novel continuous care intervention (CCI) suggest that it is possible to improve hemoglobin A1c (HbA1c) levels while simultaneously reducing diabetes medications in patients with type 2 diabetes (T2D). The CCI provided remote guidance from a health coach and physician, education in nutritional ketosis and behavior change, biometric feedback and peer support. At 1-year, 83% (n=218) of patients were retained and 60% of patients with 1-year HbA1c (123/204) achieved HbA1c <6.5%, while taking no diabetes medications or metformin only. At baseline, 121 of 218 were on at least one glycemic control medication other than metformin. A usual care comparator group (n=87 starters, n=78 completers, [90%]) showed and increase in HbA1c and medication use at 1-year. Here we quantified the cost savings associated with reduction in glycemic control medications following 1-year of CCI.

METHODS

Savings were estimated by tracking daily changes in CCI patients’ prescriptions for one year. Medication prices were estimated from goodrx.com, which organizes pricing from over 60,000 U.S. pharmacies. Medications were priced in proportion to: (i) dosage, (ii) number of tablets, or (iii) number of injections.

RESULTS

The analysis yielded an estimated baseline average annual cost of $4,438 per patient. Across the intervention group at 1-year, there was a reduction of about 46% in estimated annual cost to $2,329, with most savings from insulin reductions in the first 2-3 months. Among n=62 completing the intervention who were prescribed insulin at baseline, there was a reduction of 40% in estimated annual cost ($10,818 to $6,481 per patient).

CONCLUSIONS

In patients with T2D, a multifaceted continuous treatment led to a reduction in diabetes medication use and substantial estimated medication cost savings while simultaneously improving glycemic control.