Projected Impacts of Integrated T2D Management in Spain

An MDPI Journal of Clinical Medicinemodeling analysis estimated the one-year national impact in Spain of simultaneously meeting three biomarker targets in treated type 2 diabetes: a 1% HbA1c reduction, 5% weight reduction, and 0.5 mg/L hs-CRP reduction.

Reported outputs included projected changes in diabetes-related complications, disability-adjusted life years (DALYs) as a health-related quality-of-life metric, and direct complication-related medical cost offsets.

The one-year estimation model linked literature-derived risk estimates (primarily hazard ratios) to changes in HbA1c, weight, and hs-CRP to project shifts in complication incidence. For the joint effect of glycemia and weight, the authors reported a conservative interaction approach: a 5% weight reduction was assumed to correspond to a 0.44% HbA1c reduction in the modeled population, and the remaining HbA1c change needed to reach a 1% total reduction was then added rather than treated as fully additive with weight-related effects. No interaction with hs-CRP was modeled due to limited evidence, and uncertainty was evaluated with a probabilistic sensitivity analysis using 1,000 simulations. Results were reported across three prevalence-based scenario populations of 4,174,033, 1,832,400, and 818,110 treated patients, which the authors used to generate ranges for projected outcomes.

Across the three scenarios, the authors estimated that achieving the combined biomarker changes would reduce the annual burden of type 2 diabetes complications by 19.16% to 20.80%. The modeled complication set included microvascular and macrovascular outcomes; examples listed in the paper included retinopathy, nephropathy/chronic kidney disease, peripheral vascular disease, stroke, and myocardial infarction. Within the same one-year frame, the model estimated 1,317 to 6,568 DALYs avoided per year across scenarios, described as HRQoL-related gains associated with fewer complications. Overall, the projections attribute one-year decreases in complications and DALYs to concurrent, moderate improvements in glycemia, weight, and hs-CRP.

For economic outputs, the authors reported projected annual direct healthcare cost savings ranging from €242.77 million to €821.68 million across scenarios, alongside modeled savings of €196.86 to €296.75 per patient per year. Costs were described as diagnosis-related group (DRG)–based direct medical costs from the Spanish National Healthcare System (SNHS) perspective, expressed in 2025 euros, and applied to complication events captured in the model.