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

Preventing the progression of prediabetes to type 2 diabetes (T2D) 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.1

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 2019.2

“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 HCPLive 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.2

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.2

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).2

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%).2

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.2

“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.”

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