Care pathways for patients with diabetes in the Canary Islands: effectiveness and economic and environmental costs based on real-world data

Full title: Care Pathways for Patients with Diabetes in the Canary Islands: Effectiveness, Economic Costs, and Environmental Impact Based on Real-World Data

Funded by: Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC)

Granted amount: €8,075.00

Duration: 2 years (2025–2026)

Principal Investigator: Carmen Guirado Fuentes

Associated Researchers: Berta Ibáñez Beroiz, Cristina Valcárcel Nazco, Ignacio Oscoz Villanueva, Benjamín Rodríguez Díaz, Francisco Estupiñán Romero, Sara Trujillo Alemán, Lidia García Pérez, María del Mar Trujillo Martín, Estefanía Herrera Ramos, Sybille Kaiser Girardot

Background:

Diabetes mellitus (DM) is a chronic metabolic disease with high prevalence worldwide and particularly in the Canary Islands. Notably, 90% of cases correspond to type 2 diabetes (T2DM). This disease can lead to micro- and macrovascular complications, with high associated morbidity and mortality. Clinical Practice Guidelines (CPGs) are developed and periodically updated to identify which interventions are effective, for whom, and in what contexts. However, evidence is limited regarding the extent to which these recommendations are implemented in routine clinical practice, although adherence is generally known to be low.

Identifying care pathways (CPs), which reflect patients’ actual exposure to healthcare interventions over time, is a complex but important task, as it provides information about care adequacy, treatment adherence, and the health, economic, and environmental consequences of interventions. The availability of real-world data (RWD) is facilitating this task. The CONCEPT project and its subprojects CONCEPT-DIABETES and CONCEPTCOST have developed a standardized methodology that applies process mining to data extracted from administrative health records and electronic medical records, to identify CPs for patients with T2DM and the economic costs associated with CPs for various pathologies. These CPs can be classified based on their adherence or non-adherence to current CPG recommendations.

Another relevant aspect is the environmental footprint that different care pathways may generate. Estimating this impact is complex, but previous studies on the carbon footprint of healthcare provide various methodologies that can serve as a basis for estimating the environmental impact of different CPs for patients with T2DM.

Objectives:

General objective:

To estimate the effectiveness, economic cost, and environmental impact of the care pathways followed by patients with T2DM in the Canary Islands.

Specific objectives (SO):

  • SO1: Characterize the CPs of patients with T2DM in the Canary Islands and analyze their adherence to CPG recommendations.

  • SO2: Evaluate the effect of adherence to CPGs on clinical outcomes (mortality, avoidable hospitalizations, or changes in health status) in patients with T2DM.

  • SO3: Estimate the economic costs associated with different CPs for patients with T2DM.

  • SO4: Compare the economic costs of CPs that follow CPG recommendations versus those that do not.

  • SO5: Estimate the environmental impact (carbon footprint) of the CPs for patients with T2DM.

  • SO6: Compare the environmental footprints of CPs that follow CPG recommendations versus those that do not.

Methods:

A retrospective, longitudinal, population-based observational cohort study will be conducted using data from the Canary Islands Health Service records to identify individuals with T2DM. Extracted data will be analyzed using process mining techniques to model empirically observed CPs, determine adherence to CPGs, and estimate the health outcomes associated with specific pathways.

A resource utilization analysis and cost estimation and comparison will be carried out to identify differences between CPs that follow or do not follow CPG recommendations.

The carbon footprint of CPs will be estimated based on data sources identified through literature review and specific databases, to differentiate between pathways that adhere to or deviate from CPGs.

Applicability:

This is an evaluative research project of routine clinical practice, with a translational approach and purpose, based on scientific knowledge from CPGs and the use of RWD. Its aim is to efficiently improve care quality and promote the health of patients with T2DM.

The study will identify CPs for patients with T2DM that diverge from CPG recommendations, assess their impact on health outcomes and disease progression, and determine their economic and environmental costs. The results will be transferable to the scientific community and to clinical and health policy decision-makers. This will allow for the development of conclusions, recommendations, and interventions aimed at improving care quality and health outcomes for patients with T2DM, and promoting the economic and environmental sustainability of the healthcare system in the Canary Islands.

Contact person: Carmen Guirado Fuentes (carmen.guiradofuentes@sescs.es)