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J Diabetes Complications. 2019 Aug 15:107416. doi: 10.1016/j.jdiacomp.2019.107416. [Epub ahead of print]

Economic costs of implementing group interventions to reduce diabetes distress in adults with type 1 diabetes mellitus in the T1-REDEEM trial.

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Department of Psychiatry, University of California, San Francisco, Box 0884, San Francisco, CA 94143-0884, USA. Electronic address:
Department of Family and Community Medicine, University of California, San Francisco, Box 0900, San Francisco, CA 94143-0900, USA.
Behavioral Diabetes Institute, 5405 Oberlin Drive #100, San Diego, CA 92121, USA.
Department of Medicine, University of California, San Francisco, Box 1222, San Francisco, CA 94143-1222, USA.



This study evaluated the implementation costs of two group interventions, one focused on diabetes education (KnowIt) and one focused directly on diabetes distress (OnTrack), that reduced diabetes distress and HbA1C in adults with poorly controlled type 1 diabetes (T1DM) in the T1-REDEEM trial.


Resources used to provide interventions were enumerated using activity-based micro-costing methods. Costs were assigned to resources in 2017 US dollars. US median wage and benefit rates were used to calculate costs of staff time. Cost per unit change was calculated for diabetes distress and HbA1C.


For both interventions, per participant implementation costs were approximately $250 and cost per 1.0 percentage point (11 mmol/mol) change in HbA1C was $1400. Cost per unit change in diabetes distress was $364 for KnowIt and $335 for OnTrack. No statistically significant differences in costs were observed.


This is the first study to examine the costs of implementing interventions targeting diabetes distress in the context of T1DM. Both interventions had per participant implementation costs in the lower end of the range of previously examined diabetes self-management interventions ($219 to $5390). These inventions and their costs merit further attention because reducing diabetes distress may impact long term T1DM outcomes.




Cost analysis; Costs; Patient education; Self-management; Type 1 diabetes

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