Effective diabetes complication management is a step toward a carbon-efficient planet: an economic modeling study

Background: The management of diabetes-related complications accounts for a large share of total carbon dioxide equivalent (CO₂e) emissions. We assessed whether improving diabetes control in people with type 2 diabetes reduces CO₂e emissions, compared with those with unchanging glycemic control.

Methods: Using the IQVIA Core Diabetes Model, we estimated the impact of maintaining glycated hemoglobin (HbA_1c) at 7% (53 mmol/mol) or reducing it by 1% (11 mmol/mol) on total CO₂e/patient and CO₂e/life-year (LY). Two different cohorts were investigated: those on first-line medical therapy (cohort 1) and those on third-line therapy (cohort 2). CO₂e was estimated using cost inputs converted to carbon inputs using the UK National Health Service's carbon intensity factor. The model was run over a 50-year time horizon, discounting total costs and quality adjusted life years (QALYs) up to 5% and CO₂e at 0%.

Results: Maintaining HbA_1c at 7% (53 mmol/mol) reduced total CO₂e/patient by 18% (1546 kgCO₂e/patient) vs 13% (937 kgCO₂e/patient) in cohorts 1 and 2, respectively, and led to a reduction in CO₂e/LY gain of 15%-20%. Reducing HbA_1c by 1% (11 mmol/mol) caused a 12% (cohort 1) and 9% (cohort 2) reduction in CO₂e/patient with a CO₂e/LY gain reduction of 11%-14%.

Conclusions: When comparing people with untreated diabetes, maintaining glycemic control at 7% (53 mmol/mol) on a single agent or improving HbA_1c by 1% (11 mmol/mol) by the addition of more glucose-lowering treatment was associated with a reduction in carbon emissions.