Niels Lund, MSc is the vice president of Changing Diabetes at Novo Nordisk.

Niels Lund, MSc

Addressing Environmental and Cardiovascular Concerns in Diabetes Treatment, With Niels Lund, MSc

Despite increasing the cumulative incidence of cardiovascular complications, maintenance of HbA1c and preventing progression from prediabetes to 

 can substantially reduce a patient’s carbon footprint, according to a recent study.

“Our analysis is fairly robust, but it’s also dependent on keeping HbA1c in control,” Niels Lund, MSc, vice president of Changing Diabetes at Novo Nordisk and lead investigator of the study, told 

 in an exclusive interview. “If anything, the analysis is an important reminder to keep blood sugar in check and address other diabetes-related factors, such as blood pressure, lipids, and so on. However, that is a decision that’s also about the quality of life and is something that has to be decided between the patient and the caregiver.”

Lund and colleagues collected data on 1000 individual patients for a simulation in the IQVIA core diabetes model. Each patient was simulated 1000 times to achieve stability, and the team utilized an annual discount rate of 3.5% for health effects and 0% for environmental effects. Greenhouse gas emissions associated with T2D were estimated via avoidance of ongoing drug treatment, anticipated complications without interventions, and the necessary procedures, medications, and travel components for T2D management.

The study included 2 main scenarios: a comparison between patients >40 years who did and did not progress to T2D due to advice from a nutritionist, and a comparison between patients with well versus poorly controlled T2D. The first scenario assumed that HbA1c remained <6.5% without further progression to T2D during lifetime. All patients in the comparator arm were assumed to receive 3 lines of anti-diabetes therapy – first-line metformin, second-line metformin and DPP4 inhibitor, and third-line basal and bolus insulin.

Greenhouse gas emission was found to be 67% less over a lifetime in patients with prediabetes and no progression, driven primarily by reduced need for management of diabetes-related complications such as cardiovascular disease, renal disease, and eye diseases. Additionally, patients with well-controlled T2D exhibited 21% less greenhouse gas emissions compared to patients with uncontrolled T2D.

The study ultimately showed an extra 6 years of life over a lifetime through prediabetes management compared to natural progression. Patients who remained prediabetic also had substantially lower lifetime complication rates than those who progressed naturally (244 vs 60,167 events per 100 patients), particularly renal (73% fewer events) and eye disease (59% fewer events). However, patients remaining prediabetic had slightly higher cumulative incidence of cardiovascular complications (11% more cumulative events). This was attributed to increased longevity, as heart disease risks increase in older age, irrespective of prediabetes.

“I think there’s room for discussing and weighing carbon emissions, clinical outcomes, and economics,” Lund said. “However, one of the limitations in this area is that unlike with cost per QALYs, we don’t have a threshold. Many health systems have a fairly consistent way of assessing medicines through a cost per QALY threshold, but we don’t have that for carbon emissions.”

Editor’s Note: Lund reports that he is an employee and shareholder of Novo Nordisk.

BMJ Group. Type 2 diabetes prevention could more than halve carbon footprint linked to disease complications. Eurekalert. January 20, 2026. Accessed January 22, 2026. 

https://www.eurekalert.org/news-releases/1112970

Lund N, Maslova E, Chen J, et al. Assessment of greenhouse gas emission of type 2 diabetes management in adults: A modelling study in the UK. BMJ Open. 2026;16(1). 

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Lund highlights the value of preventive treatment in patients with prediabetes on the environment via reduced greenhouse gas emissions.

Managing Prediabetes Lowers Carbon Footprint Compared to T2D Care, With Niels Lund, MSc

Preventing the progression of prediabetes to 

 through lifestyle changes may more than halve the carbon footprint associated with disease treatment, according to a recent modeling study by the Sustainable Markets Initiative’s Health System Task Force.

Investigators from various medical organizations across Europe, including AstraZeneca and Novo Nordisk, came together to analyze the potential carbon reduction of preventive treatment of prediabetes versus standard management of T2D in adult patients. The study was conducted in response to data showing that the carbon footprint of end-to-end healthcare delivered by the National Healthcare Service in England equated to 25 megatons of carbon dioxide equivalent in 2019.

“We believe that the total patient carbon footprint, which also brings in the product carbon footprint, is influenced by many factors: medicine, equipment, transport, outpatient care, inpatient care, complications, and so on,” Niels Lund, MSc, vice president of Changing Diabetes at Novo Nordisk and lead investigator of the study, told 

 in an exclusive interview. “We zoomed in on 2 scenarios – prevention and improved care for diabetes in the UK.”

Lund and colleagues utilized the framework of the IQVIA core diabetes model after adapting it to include an environmental module – this was accomplished by replacing cost inputs with greenhouse gas (GHG) emissions associated with set interventions for T2D management. A total of 1000 patients were selected for the simulation and were simulated 1000 times each to achieve stability. The analysis was conducted over a lifetime horizon of 50 years.

The simulation was broken into 2 main scenarios; the first included a target population of adults with prediabetes, aged ≥40 years. 2 management pathways were assumed for this population – people receiving diet and exercise from a nutritionist for 4 years, adhering to it for life, and not progressing to T2D (representing the intervention arm), and people not receiving advice and progressing to T2D. The second scenario included adults with T2D, aged ≥54.5 years. This scenario’s 2 pathways were timely and effective T2D treatment and no treatment.

Ultimately, preventing the progression of prediabetes to T2D improved undiscounted life years (6.357) and quality-adjusted life years (QALYs) (3.747) versus natural progression to T2D over a lifetime horizon. Patients remaining prediabetic had fewer diabetes-related complications or events (244 vs 60,167 events per 100 patients over lifetime).

Total GHG emission associated with the care of patients with no progression to T2D was 67% less than that of those who progressed naturally. This reduction was largely due to a similar reduction in the need for management of diabetes-related complications, primarily cardiovascular disease, renal disease, and eye diseases. A modest increase in emissions was noted for disease management in patients who remained prediabetic, but this became negligible when annualised savings were estimated, which were higher than those with lifetime GHG emission savings (72% vs 67%).

The second scenario saw patients with well-controlled T2D have improved undiscounted life years (1.947) and QALYs (0.734) compared with patients with uncontrolled T2D. Care for well-controlled T2D was also associated with a 21% reduction in GHG emissions compared with uncontrolled T2D over a lifetime. This reduction was largely driven by reduced emissions for the management of complications.

“Hopefully, our findings can inspire other therapy areas outside of diabetes, and systems outside the UK,” Lund said. “When it comes to long-term disease management, these data could be relevant to see how the impact of different strategies in disease management can actually contribute to higher or lower carbon emissions.”

BMJ Group. Type 2 diabetes prevention could more than halve carbon footprint linked to disease complications. 

. January 20, 2026. Accessed January 22, 2026. 

Lund discusses a recent study detailing the comparatively lower greenhouse gas emissions caused by preventive care versus diabetes management.

Niels Lund, MSc

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