Impact of Education in Disease Management Program for Patients with Diabetes Mellitus on All-Cause Mortality: A Propensity Score-Matched Cohort Study.

INTRODUCTION

Disease management programs (DMPs) and diabetes self-management education have been associated with improved clinical outcomes and reduced mortality among patients with type 2 diabetes mellitus (T2DM). Since 2015, Dôvera Health Insurance Company has operated a diabetes DMP in Slovakia. We evaluated the association between DMP participation and all-cause mortality among patients with T2DM.

METHODS

This retrospective cohort study used administrative healthcare data from 2013 to 2024. Patients participating in structured education (EDU) were compared with two reference groups: non-enrolled patients treated by diabetologists participating in the DMP (REF_DMP) and patients receiving diabetes care outside the DMP (REF). Propensity score matching was used to create 1:1:1 matched triplets. Survival was analyzed using a piecewise Cox regression with follow-up divided into ≤ 2 years and > 2 years. Inverse probability of treatment weighting (IPTW) was used to estimate population-average effects.

RESULTS

A total of 4702 EDU patients were successfully matched to controls from both reference groups, resulting in a matched cohort of 14,106 patients. During a median follow-up of 5.04 years, 1695 deaths occurred. Compared with the REF group, participation in structured education was associated with a 57% lower mortality risk during the first 2 years of follow-up (HR 0.43, 95% CI 0.30-0.60) and a 32% lower risk afterwards (HR 0.68, 95% CI 0.57-0.81). REF_DMP showed no survival benefit. IPTW analysis demonstrated a similar time-dependent pattern, with estimated reductions in mortality risk of 60% during the first 2 years (HR 0.40, 95% CI 0.28-0.57) and 31% beyond (HR 0.69, 95% CI 0.59-0.80).

CONCLUSION

Undergoing education within DMP was associated with a substantial reduction in all-cause mortality among patients with T2DM. Although attenuated over time, a significant benefit persisted throughout long-term follow-up. These findings support structured education as a key component of diabetes DMPs and suggest that broader implementation may improve population-level outcomes.