Economic impact of education and empowerment interventions in diabetes care: a two-year prospective longitudinal analysis in a tertiary care population

Background: Diabetes mellitus imposes a substantial economic burden on patients and healthcare systems, particularly in low- and middle-income countries. Objective: To evaluate longitudinal changes in direct and indirect costs of diabetes care and identify predictors of cost reduction following an educational and empowerment-based intervention. Methods: A prospective longitudinal controlled interventional study (quasi-experimental) was conducted over 24 months among adults with type 2 diabetes mellitus at a tertiary care hospital. Patient-level data on direct medical expenses, ancillary costs, and clinical parameters were analyzed using mixed-effects and regression models. Results: A significant reduction in direct cost and ancillary fees, such as travel and parking, was observed from baseline to 24 months (p<0.001). Mixed-effects modeling confirmed significant temporal reductions in costs at each follow-up (β = -3,117.05 at 24 months; 95% CI: -3,224.01 to -3,010.09). Furthermore, clusters of moderate, gradual, and high responders were identified. Multivariable regression showed that baseline cost (β = 0.582, p<0.001) and HbA1c (β = -611.53, p < 0.001) as independent predictors of cost reduction. Conclusion: Education and empowerment lead to reductions in direct and indirect costs over two years, suggesting improved cost efficiency in diabetes mellitus management.