Diabetes Management in Racial/Ethnic Minority Populations: Evaluating Economic and Humanistic Outcomes

Type 2 diabetes disproportionately affects historically underserved populations, leading to higher incidence rates, complication burden, suboptimal outcomes, and financial strain. This dissertation explores the economic and humanistic outcomes in individuals with suboptimally controlled type 2 diabetes belonging to racial and ethnic minority communities receiving care at the University of Illinois Hospital and Health Sciences System. In Chapter 1, an overview of diabetes etiology, treatment guidelines, and disease burden are provided, emphasizing the need for targeted efforts to enhance disease management and health equity. It introduces a clinical pharmacist and community health worker team-based mobile health intervention for type 2 diabetes adherence support (mDAS) and the rationale for its implementation, setting the stage for the subsequent research. In Chapter 2, the costs of implementing the mDAS intervention are examined from a health system perspective. A comparison of medical visits and associated costs between intervention and usual care groups showed no significant differences, suggesting that team-based care models can be integrated into practice without additional financial burden. In Chapter 3, the psychometric properties of the EQ-5D-3L, a generic preference-based measure of health-related quality of life (HRQL), are examined in the mDAS study population. This study contributes to the understanding of HRQL measures in diverse populations and informs the selection of appropriate patient-reported outcomes for future studies. Chapter 4 evaluates the long-term cost-effectiveness of the mDAS intervention using a cost-effectiveness Markov model. Study findings suggest that the intervention can result in reduced healthcare costs and increased quality-adjusted life years over 5-year, 10-year, and lifetime horizons, with the benefits becoming more pronounced over time. Chapter 5 discusses key findings, implications, and future research opportunities. The dissertation highlights the potential of interdisciplinary, technology-driven interventions to improve both clinical outcomes and cost-effectiveness, especially in historically underserved populations.