Effects of the Copenhagen Disease Management Program for Type 2 Diabetes on Healthcare Utilization

The aim of providing disease management programs (DMPs) for T2D is to increase the understanding of disease etiology, enhance self-care management, and promote effective strategies for use of healthcare services. Despite large expenses associated with DMPs within universal welfare states, no current evidence exists on healthcare utilization following participation in DMPs.

The source population covered all individuals living in Copenhagen Municipality with diagnosed T2D during the period 2016-2021 (n = 21,132) and of which 2323 individuals were enrolled in the DMP (i.e., cases). Cases were matched with 6812 nonparticipants (i.e., controls) on sociodemography and disease status and information from nationwide registers. Difference-in-difference estimates were conducted to assess the effects of the DMP program on the utilization of healthcare services, general practitioner visits, checkups with podiatrists, and diabetic retinopathy screening. We also studied subgroup effects within socioeconomic groups.

Among individuals enrolled in the DMP, the proportion adhering to the recommendations of one yearly visit increased for foot (15%) and eye (10%) examinations, while the average number of GP visits decreased (-10%). No significant changes were observed among controls. Substantial gains from enrolling in the DMP were seen in selected subgroups of the population; for example, individuals with a long history of T2D increased participation rates in foot (58%) and eye (38%) examinations.

The results suggest that patients with longstanding T2D and their primary GP have insufficient resources or competencies to promote disease management and underline the value of the DMP in promoting care-seeking and navigating the healthcare system.