{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T22:59:10Z","timestamp":1768345150113,"version":"3.49.0"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Despite substantial advances in treatment strategies for patients with type 2 diabetes mellitus (T2DM), its complication, particularly sarcopenia, has emerged as a global healthcare challenge. Pay-for-performance (P4P), an incentive-based payment scheme, has long been used to improve the quality of care; however, few studies have explored its effect on sarcopenia prevention. Therefore, we conducted a nested case\u2013control study to investigate the association between P4P participation and the risk of sarcopenia among patients with T2DM. Materials and Methods: Using a large claims dataset, we identified individuals aged 20\u201370 years with newly diagnosed T2DM between 2001 and 2010 in Taiwan. All enrollees were followed up until 2013 to determine the occurrence of sarcopenia. For each case, we randomly matched two controls without sarcopenia. The risk of sarcopenia in relation to P4P participation was estimated by fitting conditional logistic regression to yield the adjusted odds ratio (aOR) and corresponding 95% confidence interval (CI). Results: A total of 3475 individuals with sarcopenia and 6948 matched controls were included. Patients enrolled in the P4P program had a lower risk of sarcopenia than their matched counterparts (aOR = 0.66; 95% CI: 0.61\u20130.74). Earlier P4P enrollment (within 1 year of T2DM diagnosis) and high-intensity P4P participation were associated with additional reductions in sarcopenia risk. Conclusions: Integrating P4P into routine T2DM care may help prevent sarcopenia, highlighting the importance of interdisciplinary collaboration and timely program implementation.<\/jats:p>","DOI":"10.3390\/medicina62010161","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T15:52:57Z","timestamp":1768319577000},"page":"161","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Use of the Pay-for-Performance Program in Reducing Sarcopenia Risk: A Nested Case\u2013Control Study Among Patients with Type 2 Diabetes Mellitus"],"prefix":"10.3390","volume":"62","author":[{"given":"Hui-Ju","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pin-Fan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Metabolism &Endocrinology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"},{"name":"School of Medicine, Tzu Chi University, Hualien 97004, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chieh-Tsung","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9051-0351","authenticated-orcid":false,"given":"Ming-Chi","family":"Lu","sequence":"additional","affiliation":[{"name":"School of Medicine, Tzu Chi University, Hualien 97004, Taiwan"},{"name":"Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei-Jen","family":"Chen","sequence":"additional","affiliation":[{"name":"Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan 33325, Taiwan"},{"name":"School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien 97004, Taiwan"},{"name":"Center of Sports Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9865-7101","authenticated-orcid":false,"given":"Tzung-Yi","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan"},{"name":"Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 70428, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Baechle, J.J., Chen, N., Makhijani, P., Winer, S., Furman, D., and Winer, D.A. (2023). Chronic inflammation and the hallmarks of aging. Mol. Metab., 74.","DOI":"10.1016\/j.molmet.2023.101755"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the Global Burden of Disease Study 2021","volume":"402","author":"Ong","year":"2023","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.2337\/dc18-1226","article-title":"The economic burden of elevated blood glucose levels in 2017: Diagnosed and undiagnosed diabetes, gestational diabetes mellitus, and prediabetes","volume":"42","author":"Dall","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"26","DOI":"10.2337\/dci23-0085","article-title":"Economic Costs of Diabetes in the U.S. in 2022","volume":"47","author":"Parker","year":"2024","journal-title":"Diabetes Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s13098-021-00707-7","article-title":"The prevalence and risk factors of sarcopenia in patients with type 2 diabetes mellitus: A systematic review and meta-analysis","volume":"13","author":"Ai","year":"2021","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1111\/dom.15338","article-title":"In people with type 2 diabetes, sarcopenia is associated with the incidence of cardiovascular disease: A prospective cohort study from the UK Biobank","volume":"26","author":"Boonpor","year":"2024","journal-title":"Diabetes Obes. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Pascual-Fern\u00e1ndez, J., Fern\u00e1ndez-Montero, A., C\u00f3rdova-Mart\u00ednez, A., Pastor, D., Mart\u00ednez-Rodr\u00edguez, A., and Roche, E. (2020). Sarcopenia: Molecular pathways and potential targets for intervention. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21228844"},{"key":"ref_8","first-page":"442","article-title":"Type 2 diabetes and its impact on the immune system","volume":"16","author":"Berbudi","year":"2020","journal-title":"Curr. Diabetes Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.puhe.2024.09.005","article-title":"Pay-for-performance in Taiwan: A systematic review and meta-analysis of the empirical literature","volume":"236","author":"Kang","year":"2024","journal-title":"Public Health"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Conway, A., and Satin, D. (2022). The role of pay-for-performance in reducing healthcare disparities: A narrative literature review. Prev. Med., 164.","DOI":"10.1016\/j.ypmed.2022.107274"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"de Bruin, S.R., Baan, C.A., and Struijs, J.N. (2011). Pay-for-performance in disease management: A systematic review of the literature. BMC Health Serv. Res., 11.","DOI":"10.1186\/1472-6963-11-272"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Huang, H.-L., Kung, C.-Y., Wang, S.-M., Kung, P.-T., Lin, Y.-H., Chiu, L.-T., and Tsai, W.-C. (2021). Effects of body mass index and pay-for-performance program on risk of death in patients with type 2 diabetes: A nationwide cohort study. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18094648"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wu, Y.-F., Chen, M.-Y., Chen, T.-H., Wang, P.-C., Peng, Y.-S., and Lin, M.-S. (2021). The effect of pay-for-performance program on infection events and mortality rate in diabetic patients: A nationwide population-based cohort study. BMC Health Serv. Res., 21.","DOI":"10.1186\/s12913-021-06091-2"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s11136-013-0502-x","article-title":"Is a diabetes pay-for-performance program cost-effective under the National Health Insurance in Taiwan?","volume":"23","author":"Tan","year":"2014","journal-title":"Qual. Life Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1093\/heapol\/czt056","article-title":"Does the pay-for-performance programme reduce the emergency department visits for hypoglycaemia in type 2 diabetic patients?","volume":"29","author":"Yu","year":"2014","journal-title":"Health Policy Plan."},{"key":"ref_16","unstructured":"(2025, January 14). The Introduction of the National Health Insurance Program, Available online: https:\/\/dep.mohw.gov.tw\/DOS\/cp-5301-62356-113.html."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Lin, M.-H., Chiu, S.-Y., Chang, P.-H., Lai, Y.-L., Chen, P.-C., and Ho, W.-C. (2020). Hyperlipidemia and statins use for the risk of new diagnosed sarcopenia in patients with chronic kidney: A population-based study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051494"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chou, C.-W., Kung, P.-T., Chou, W.-Y., and Tsai, W.-C. (2019). Pay-for-performance programmes reduce stroke risks in patients with type 2 diabetes: A national cohort study. BMJ Open, 9.","DOI":"10.1136\/bmjopen-2018-026626"},{"key":"ref_19","first-page":"1","article-title":"Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey","volume":"4","author":"Liu","year":"2006","journal-title":"J. Health Manag."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/0895-4356(92)90133-8","article-title":"Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases","volume":"45","author":"Deyo","year":"1992","journal-title":"J. Clin. Epidemiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.2147\/DMSO.S186600","article-title":"Sarcopenia and type 2 diabetes mellitus: A bidirectional relationship","volume":"12","author":"Mesinovic","year":"2019","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kyeremanteng, K., Robidoux, R., D\u2019egidio, G., Fernando, S.M., and Neilipovitz, D. (2019). An analysis of pay-for-performance schemes and their potential impacts on health systems and outcomes for patients. Crit. Care Res. Pract., 2019.","DOI":"10.1155\/2019\/8943972"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hung, J.Y., Chen, P.F., Livneh, H., Chen, Y.Y., Guo, H.R., and Tsai, T.Y. (2017). Long-term effectiveness of the Diabetes Conversation Map Program: A prepost education intervention study among type 2 diabetic patients in Taiwan. Medicine, 96.","DOI":"10.1097\/MD.0000000000007912"},{"key":"ref_24","first-page":"e18","article-title":"Factors related to continuing care and interruption of P4P program participation in patients with diabetes","volume":"22","author":"Yen","year":"2016","journal-title":"Am. J. Manag. Care"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"King, C., Lavergne, M.R., McGrail, K., and Strumpf, E. (2025). The effect of enrolment policies on patient affiliation to a family physician: A quasi-experimental evaluation in Canada. Health Policy, 156.","DOI":"10.1016\/j.healthpol.2025.105313"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Farcher, R., Graber, S.M., Th\u00fcring, N., Blozik, E., and Huber, C.A. (2023). Does the implementation of an incentive scheme increase adherence to diabetes guidelines? A retrospective cohort study of managed care enrollees. BMC Health Serv. Res., 23.","DOI":"10.1186\/s12913-023-09694-z"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Moshapa, F.T., Riches-Suman, K., and Palmer, T.M. (2019). Therapeutic targeting of the proinflammatory IL-6-JAK\/STAT signalling pathways responsible for vascular restenosis in type 2 diabetes mellitus. Cardiol. Res. Pract., 2019.","DOI":"10.1155\/2019\/9846312"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Weinberg Sibony, R., Segev, O., Dor, S., and Raz, I. (2024). Overview of oxidative stress and inflammation in diabetes. J. Diabetes, 16.","DOI":"10.1111\/1753-0407.70014"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez, P., Lozano, P., Ros, G., and Solano, F. (2023). Hyperglycemia and oxidative stress: An integral, updated and critical overview of their metabolic interconnections. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24119352"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Cecconi, C., Adams, R., Cardone, A., Declaye, J., Silva, M., Vanlerberghe, T., Guldemond, N., Devisch, I., and van Vugt, J. (2025). Generational differences in healthcare: The role of technology in the path forward. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1546317"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.cyto.2015.01.007","article-title":"Estrogen alters baseline and inflammatory-induced cytokine levels independent from hypothalamic\u2013pituitary\u2013adrenal axis activity","volume":"72","author":"Shivers","year":"2015","journal-title":"Cytokine"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/161\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T16:16:43Z","timestamp":1768321003000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["medicina62010161"],"URL":"https:\/\/doi.org\/10.3390\/medicina62010161","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]}}}