Observed changes in clinical parameters and healthcare costs among patients enrolled in a diabetes management program...

In Brazil, Hapvida NotreDame, the largest supplementary health system in the country, implemented the Viver Bem Program (VBP), a structured chronic care initiative designed to support patients with type 2 diabetes mellitus (T2DM) in routine clinical practice.

To evaluate longitudinal changes in clinical, laboratory, and healthcare utilization parameters among patients with T2DM enrolled in the VBP.

This retrospective single-arm longitudinal real-world study analyzed data from adult patients (≥ 18 years) with laboratory-confirmed T2DM (fasting plasma glucose ≥ 200 mg/dL or glycated hemoglobin ≥ 6.5%) enrolled in the VBP between 2020 and 2023. Data were extracted from integrated administrative and clinical information systems and analyzed in a pseudonymized format. Anthropometric, hemodynamic, and laboratory parameters were assessed at baseline and at the last available follow-up. Multivariable linear regression was used to explore factors associated with observed changes. Healthcare costs were compared with a non-enrolled control group meeting the same eligibility criteria.

A total of 23,516 patients were included, with a mean follow-up of 20.6 months. Statistically significant within-group changes were observed in weight, abdominal circumference, body mass index, blood pressure, glycated hemoglobin, lipid profile, and serum creatinine (all p < 0.001), although absolute magnitudes were small. In multivariable analyses, age and male sex were consistently associated with anthropometric changes, while longer program participation was associated with reduced abdominal circumference. Model explanatory power was limited, with low R² values across outcomes. In cost analyses, VBP participants had higher outpatient consultation costs but lower costs related to emergency room visits, exams, treatments, and small procedures, while hospitalization costs were similar between groups.

Enrollment in the Viver Bem Program was associated with modest but statistically significant within-individual changes in intermediate clinical and laboratory parameters, as well as differences in healthcare utilization patterns. These findings support the feasibility of integrated chronic care programs in large private health systems, although causal inferences regarding clinical benefit and cost-effectiveness cannot be established.

Not applicable.