Impact of Education in Disease Management Program for Patients with Diabetes Mellitus on All-Cause Mortality: A Propensity Score-Matched Cohort Study

Disease management programs (DMPs) and diabetes self-management education have been associated with improved clinical outcomes and reduced mortality among patients with type 2 diabetes mellitus (T2DM). Since 2015, Dôvera Health Insurance Company has operated a diabetes DMP in Slovakia. We evaluated the association between DMP participation and all-cause mortality among patients with T2DM. This retrospective cohort study used administrative healthcare data from 2013 to 2024. Patients participating in structured education (EDU) were compared with two reference groups: non-enrolled patients treated by diabetologists participating in the DMP (REF_DMP) and patients receiving diabetes care outside the DMP (REF). Propensity score matching was used to create 1:1:1 matched triplets. Survival was analyzed using a piecewise Cox regression with follow-up divided into ≤ 2 years and > 2 years. Inverse probability of treatment weighting (IPTW) was used to estimate population-average effects. A total of 4702 EDU patients were successfully matched to controls from both reference groups, resulting in a matched cohort of 14,106 patients. During a median follow-up of 5.04 years, 1695 deaths occurred. Compared with the REF group, participation in structured education was associated with a 57% lower mortality risk during the first 2 years of follow-up (HR 0.43, 95% CI 0.30–0.60) and a 32% lower risk afterwards (HR 0.68, 95% CI 0.57–0.81). REF_DMP showed no survival benefit. IPTW analysis demonstrated a similar time-dependent pattern, with estimated reductions in mortality risk of 60% during the first 2 years (HR 0.40, 95% CI 0.28–0.57) and 31% beyond (HR 0.69, 95% CI 0.59–0.80). Undergoing education within DMP was associated with a substantial reduction in all-cause mortality among patients with T2DM. Although attenuated over time, a significant benefit persisted throughout long-term follow-up. These findings support structured education as a key component of diabetes DMPs and suggest that broader implementation may improve population-level outcomes.