The Community Diabetes Education (CoDE) program: cost-effectiveness and health outcomes

Am J Prev Med. 2014 Dec;47(6):771-9. doi: 10.1016/j.amepre.2014.08.016. Epub 2014 Nov 18.


Background: Limited evidence exists regarding the long-term effects of community health worker-led diabetes management programs on health outcomes and cost-effectiveness, particularly in low-income, ethnic minority populations.

Purpose: To examine the long-term cost-effectiveness and improvements in diabetes-related complications of a diabetes education and management intervention led by community health workers among uninsured Mexican Americans.

Methods: Clinical data, changes in hemoglobin A1c over 12 months, and costs from an RCT of 180 uninsured Mexican Americans with type 2 diabetes conducted in 2006 were utilized for secondary analyses in 2012. Simulation modeling was used to estimate long-term cost and health outcomes using the validated Archimedes Model. The absolute differences for the incremental cost-effectiveness ratios and cumulative incidence of diabetes-related complications were derived by comparing intervention and control groups.

Results: During a 20-year time horizon, participants who received the intervention would be expected to have significantly lower hemoglobin A1c levels (p<0.001), fewer foot ulcers (p<0.001), and a reduced number of foot amputations (p=0.005) in comparison with a control group receiving usual medical care. An incremental cost-effectiveness ratio of $355 per quality-adjusted life year gained was estimated for intervention participants during the same time period.

Conclusions: A simulated clinical trial suggests that a community health worker-led diabetes intervention is a cost-effective way to reduce diabetes-related complications for uninsured Mexican Americans during a 20-year horizon in comparison to usual medical care.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Diabetes Complications / diagnosis
  • Diabetes Complications / prevention & control*
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / therapy
  • Female
  • Glycated Hemoglobin A / analysis
  • Health Education / methods*
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Male
  • Mexican Americans* / education
  • Mexican Americans* / statistics & numerical data
  • Middle Aged
  • Patient Outcome Assessment
  • Poverty
  • Program Evaluation
  • Quality-Adjusted Life Years
  • Self Care / methods*
  • United States


  • Glycated Hemoglobin A
  • Hypoglycemic Agents