Computer simulation models of pre-diabetes populations: a systematic review protocol

Comparing the Lifestyle Interventions for Prediabetes: An Integrated Microsimulation and Population Simulation Model

We developed a model to compare the impacts of different lifestyle interventions among prediabetes individuals and to identify the optimal age groups for such interventions. A stochastic simulation was developed to replicate the prediabetes and diabetes trends (1997-2010) in the U.S. adult population. We then simulated the population-wide impacts of three lifestyle diabetes prevention programs, i.e., the Diabetes Prevention Program (DPP), DPP-YMCA, and the Healthy Living Partnerships to Prevent Diabetes (HELP-PD), over a course of 10, 15 and 30 years. Our model replicated the temporal trends of diabetes in the U.S. adult population. Compared to no intervention, the diabetes incidence declined 0.3 per 1,000 by DPP, 0.2 by DPP-YMCA, and 0.4 by HELP-PD over the 15-year period. Our simulations identified HELP-PD as the most cost-effective intervention, which achieved the highest 10-year savings of $38 billion for those aged 25-65, assuming all eligible individuals participate in the intervention and considering intervention achievement rates. Our model simulates the diabetes trends in the U.S. population based on individual-level longitudinal data. However, it may be used to identify the optimal intervention for different subgroups in defined populations.

Decision models of prediabetes populations: A systematic review

AIMS

With evidence supporting the use of preventive interventions for prediabetes populations and the use of novel biomarkers to stratify the risk of progression, there is a need to evaluate their cost-effectiveness across jurisdictions. Our aim is to summarize and assess the quality and validity of decision models and model-based economic evaluations of populations with prediabetes, to evaluate their potential use for the assessment of novel prevention strategies and to discuss the knowledge gaps, challenges and opportunities.

MATERIALS AND METHODS

We searched Medline, Embase, EconLit and NHS EED between 2000 and 2018 for studies reporting computer simulation models of the natural history of individuals with prediabetes and/or we used decision models to evaluate the impact of treatment strategies on these populations. Data were extracted following PRISMA guidelines and assessed using modelling checklists. Two reviewers independently assessed 50% of the titles and abstracts to determine whether a full text review was needed. Of these, 10% was assessed by each reviewer to cross-reference the decision to proceed to full review. Using a standardized form and double extraction, each of four reviewers extracted 50% of the identified studies.

RESULTS

A total of 29 published decision models that simulate prediabetes populations were identified. Studies showed large variations in the definition of prediabetes and model structure. The inclusion of complications in prediabetes (n = 8) and type 2 diabetes (n = 17) health states also varied. A minority of studies simulated annual changes in risk factors (glycaemia, HbA1c, blood pressure, BMI, lipids) as individuals progressed in the models (n = 7) and accounted for heterogeneity among individuals with prediabetes (n = 7).

CONCLUSIONS

Current prediabetes decision models have considerable limitations in terms of their quality and validity and do not allow evaluation of stratified strategies using novel biomarkers, highlighting a clear need for more comprehensive prediabetes decision models.