Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network
Purpose of Review
To advance our understanding of the impacts of policies and programs aimed at improving detection, engagement, prevention, and clinical diabetes management in the USA, we synthesized findings from a network of studies that used natural experiments to evaluate diabetes health policies and programs.
Studies from the Natural EXperiments for Translation in Diabetes (NEXT-D) network used rigorous longitudinal quasi-experimental study designs (e.g., interrupted time series) and analytical methods (e.g., difference-in-differences) to augment causal inference. Investigators partnered with health system stakeholders to evaluate whether glucose testing rates changed from before-to-after clinic interventions (e.g., integrating electronic screening decision prompts in New York City) or employer programs (e.g., targeted messaging and waiving copayments for at-risk employees). Other studies examined participation and behavior change in low- (e.g., wellness coaching) or high-intensity lifestyle modification programs (e.g., diabetes prevention program-like interventions) offered by payers or employers. Lastly, studies assessed how employer health insurance benefits impacted healthcare utilization, adherence, and outcomes among people with diabetes. NEXT-D demonstrated that low-intensity interventions to facilitate glucose testing and enhance engagement in lifestyle modification were associated with small improvements in weight but large improvements in screening and testing when supported by electronic health record-based decision-support. Regarding high-intensity diabetes prevention program-like lifestyle programs offered by payers or employers, enrollment was modest and led to weight loss and marginally lower short-term health expenditures. Health plans that incentivize patient behaviors were associated with increases in medication adherence. Meanwhile, shifting patients to high-deductible health plans was associated with no change in medication use and preventive screenings, but patients with diabetes delayed accessing healthcare for acute complications (e.g., cellulitis). Findings were more pronounced among lower-income patients, who experienced increased rates and acuity of emergency department visits for diabetes complications and other high-severity conditions.
Findings from NEXT-D studies provide informative data that can guide programs and policies to facilitate detection, prevention, and treatment of diabetes in practice.
KeywordsDiabetes Policy Natural experiment Prevention Clinical management
The NEXT-D Study Writing Group members are the guarantors for the work, including the study designs, access to data, and decision to submit and publish the manuscript.
The opinions expressed herein and the interpretation and reporting of these data are the responsibility of the authors and are not official recommendations, interpretations, or policies of the Centers for Disease Control and Prevention, National Institutes of Health, or the US Government.
The NEXT-D network was supported by a cooperative agreement jointly funded by the Centers for Disease Control and Prevention  and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) under CDC Funding Opportunity Announcement (FOA) Number: RFA-DP10-002, entitled Natural Experiments and Effectiveness Studies to Identify the Best Policy and System Level Practices to Prevent Diabetes and Its Complications.
Dr. Ali also receives support from the NIDDK-funded Georgia Center for Diabetes Translation Research (P30 DK111024).
Drs. Schmittdiel, Ross-Degnan, and Wharam also receive support from the NIDDK-funded Health Delivery Systems Center for Diabetes Translational Research (P30 DK092924).
The NEXT-D Study Group comprises additional investigators, namely:
• Harvard Medical School and Harvard Pilgrim Healthcare Institute: Steve Soumerai, Emma Eggleston, Christine Lu, Fang Zhang
• University of California at Los Angeles: Tannaz Moin, Susan L. Ettner, Norman Turk, Lindsay Kimbro
• Kaiser Permanente: Sara Adams, Mindy Boccio, Nancy Goler, Rashel Sanna, Andromache Fargeix, Victoria George, Romain Neugebauer, Assiamira Ferrara, Susan Brown
• Mount Sinai: Nancy Sohler, Brenda Matti, Edwin Young, Carolyn Chu, Francisco Perez Mata, Julian Botta, Pindan Hao, Carolina Hurtado
• Northwestern University: Margaret Moran, Ray Kang, Andrew Cooper, Matthew O’Brien, David Liss, Joyce Tang, Ann Holmes, Chandan Saha
• Centers for Disease Control and Prevention: Bernice Moore, Heather Devlin, Patricia Shea
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Sandy Garfield
The NEXT-D investigators would like to acknowledge collaborative and administrative support from the following stakeholders: United Health Group: Bob Luchs, Charlie Chan, Abigail Keckhafer, Anya Kirvan, Sam Ho, Deneen Vojta, and Ted Prospect.
Compliance with Ethical Standards
Conflict of Interest
Mohammed K. Ali, Frank Wharam, O. Kenrik Duru, Julie Schmittdiel, Ronald T. Ackermann, Jeanine Albu, Dennis Ross-Degnan, Christine M. Hunter, Carol Mangione, and Edward W. Gregg declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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