{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T22:51:07Z","timestamp":1773528667558,"version":"3.50.1"},"reference-count":54,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Novo Nordisk A\/S"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,21]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      The carbon footprint of end-to-end healthcare deliveries by the National Health Service in England totalled 25.0 megatons of carbon dioxide equivalent (CO\n                      <jats:sub>2<\/jats:sub>\n                      e) in 2019. Optimal and sustainable healthcare can lead to better health outcomes as well as a lower environmental footprint.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the potential impact of prevention and effective management of type 2 diabetes mellitus (T2DM) in adults on both the clinical outcomes and greenhouse gas (GHG) emissions in the UK healthcare setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design and methods<\/jats:title>\n                    <jats:p>We incorporated an environmental module into the existing IQVIA core diabetes model to estimate the impact of improving clinical outcomes on GHG emissions over a lifetime horizon. We assessed two hypothetical scenarios: (1) preventing progression from pre-diabetes to T2DM through diet and exercise versus no intervention and natural disease progression to T2DM; and (2) well-controlled T2DM using interventions with clinical benefit on glycosylated haemoglobin (HbA1c), and renal and cardiovascular outcomes versus uncontrolled T2DM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Preventing progression to T2DM led to 6.357 additional undiscounted life years and 67% less kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e emissions compared with subsequent natural progression to T2DM for a person with pre-diabetes over a lifetime (emissions of 9586\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e over 37.115 years vs 28\u2009716\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e over 30.758 years, respectively). Well-controlled T2DM led to 1.947 additional undiscounted life years and 21% less kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e emissions per patient over a lifetime compared with uncontrolled T2DM (emissions of 14\u2009545\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e over 22.772 years vs 18\u2009516\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e over 20.825 years, respectively). In both scenarios, the GHG emission savings were primarily due to reduced emissions related to avoidance of treating complications of T2DM including cardiovascular, renal and eye diseases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Effective prevention and management of T2DM through implementation of evidence-based clinical guidelines can improve patient outcomes while reducing the healthcare-related environmental impacts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-106299","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T23:55:16Z","timestamp":1768953316000},"page":"e106299","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Assessment of greenhouse gas emission of type 2 diabetes management in adults: a modelling study in the UK"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1307-0837","authenticated-orcid":false,"given":"Niels","family":"Lund","sequence":"first","affiliation":[{"name":"Novo Nordisk A\/S, Bagsv\u00e6rd, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ekaterina","family":"Maslova","sequence":"additional","affiliation":[{"name":"BioPharmaceuticals Medical, AstraZeneca Cambridge Biomedical Campus, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jieling","family":"Chen","sequence":"additional","affiliation":[{"name":"BioPharmaceuticals, AstraZeneca R&D Gaithersburg, Gaithersburg, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Giannini","sequence":"additional","affiliation":[{"name":"London West End Bupa Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar","family":"Soro","sequence":"additional","affiliation":[{"name":"London West End Bupa Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Culligan","sequence":"additional","affiliation":[{"name":"London West End Bupa Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glyn","family":"Richards","sequence":"additional","affiliation":[{"name":"London West End Bupa Centre, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loveleen","family":"Taneja","sequence":"additional","affiliation":[{"name":"IQVIA, Gurugram, Haryana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shanky","family":"Varghese","sequence":"additional","affiliation":[{"name":"IQVIA, Gurugram, Haryana, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4164-0271","authenticated-orcid":false,"given":"Yuxin","family":"Li","sequence":"additional","affiliation":[{"name":"IQVIA UK, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiwei","family":"Xu","sequence":"additional","affiliation":[{"name":"IQVIA Netherlands, Amsterdam, Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"IQVIA Spain, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joice","family":"Valentim","sequence":"additional","affiliation":[{"name":"F Hoffmann-La Roche AG, Basel, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscille de La","family":"Tour","sequence":"additional","affiliation":[{"name":"Sanofi, Lyon, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiona","family":"Adshead","sequence":"additional","affiliation":[{"name":"Sustainable Healthcare Coalition, Newton Abbot, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Moore","sequence":"additional","affiliation":[{"name":"Sustainable Healthcare Coalition, Newton Abbot, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Puggina","sequence":"additional","affiliation":[{"name":"GSK, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"2026012015550919000_16.1.e106299.1","unstructured":"International Diabetes Federation . 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