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 type 2 diabetes (T2D) can substantially reduce a patient’s carbon footprint, according to a recent study.1

“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 HCPLive 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.1,2

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.2

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.2

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.1

“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.

References

1. 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

2. 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). doi:10.1136/bmjopen-2025-106299