Understanding Inadequate Care during Management of Type-2 Diabetes Mellitus: Examining Patient and Health System Factors

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2021-12

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Abstract 1: Aim: Noncompliance to following evidence-based guidelines in managing type 2 diabetes mellitus (T2D) can be considered inadequate care and can result in increased risk of diabetes-related complications. This study aims to better understand inadequate T2D care by examining its prevalence and associated characteristics. Methods: A retrospective cohort analysis was conducted, using most recently available Medical Expenditure Panel Survey data. The American Diabetes Association guidelines were used as a basis for defining inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, laboratory evaluation, and physical examination. Prevalence was measured using descriptive statistics, and associated characteristics were measured using bivariate analysis. Results: The study cohort consisted of 1,665 individuals (survey weighted: 22,385,168). Results showed prevalence of 26%, 32%, 43%, 38%, and 28% of inadequate care for metrics lifestyle management, immunization, pharmacologic therapy, laboratory evaluation, and physical examination, respectively. Eighteen out of 19 of characteristics measured were associated with at least one category of inadequate care. Conclusion: Inadequate care is a pervasive issue in the management of T2D. In each of the five categories of inadequate care examined, prevalence was over 25%. Associated characteristics of inadequate care included systematic, physician, and patient factors. These findings suggest that additional research is warranted to further expand on the causes and consequences of inadequate care.

Abstract 2: Non-adherence to evidence-based guidelines is major issue when managing type 2 diabetes mellitus (T2DM) that can result in increased risk of diabetes-related complications. This study aims to examine the predictors of inadequate T2DM care, incorporating patient, physician, and health system factors. Methods: A retrospective longitudinal analysis using Medical Expenditure Panel Survey was conducted. Inadequate Care was defined using American Diabetes Association Standards of Diabetes guidelines, resulting in five categories: immunization, pharmacologic therapy, lifestyle management, laboratory evaluation, and physical examination. A logistic regression model was used to estimate effects of patient, physician, and health systems factors on inadequate care. Results: The study cohort consisted of 1,491 individuals, representing 14,379,304 individuals. Prevalence of inadequate care was estimated at 27%, 44%, 24%, 31%, and 25% of inadequate care for metrics immunization, pharmacologic therapy, lifestyle management, laboratory evaluation, and physical examination, respectively. Fourteen out of 19 of the predictors measured were associated with at least one category of inadequate care. Conclusions: Inadequate T2DM care is an extensive issue, with a variety of associated factors, including patient, physician, and health system factors. Some characteristics, including diabetes complications severity index, insurance type, poverty level, and usual diabetes care facility were associated with over a 100% increase in inadequate care received. The study findings may inform the development of intervention programs to improve adherence to ADA guidelines on T2D management.

Abstract 3: OBJECTIVE: To estimate the effects of inadequate type 2 diabetes mellitus (T2D) care on health outcomes, utilizing a model that incorporates patient, physician, and health-system factors. METHODS: The most recently available (years 2016 – 2018) Medical Expenditure panel survey longitudinal data was used to identify adults with type 2 diabetes who had received inadequate diabetes care. American Diabetes Association Standards of Diabetes guidelines were used to define inadequate care, resulting in five categories: lifestyle management, immunization, pharmacologic therapy, physical examination, and laboratory evaluation. For each of the five categories, propensity score 1:1 matching was used to match individuals who received inadequate care to similar individuals who did not. After matching, cohorts were followed for one year. The cohorts were compared by total healthcare expenditure change from baseline, total emergency healthcare visits change from baseline, total newly developed diabetes related complications, and total days absent from school or work change from baseline. RESULTS: 1,619 adults with T2D, representing 15,781,346 individuals met study inclusion criteria, of which 22.60%, 22.80%, 49.21%, 23,93%, and 23,45% received inadequate lifestyle management, immunizations, pharmacologic therapies, physical examinations, and laboratory tests, respectively. After propensity score matching, those who had received inadequate care had increased healthcare expenditure change from baseline and more new diabetes related complications in the following year. After adjusting for residual covariate imbalance, those that had received inadequate pharmacologic therapies had approximately 0.20 increased instances of emergency healthcare utilization and 0.10 increase in new diabetes related complications. Those that had received inadequate laboratory tests had 0.26 additional increased instances emergency healthcare utilization. CONCLUSION: Inadequate T2D care is an extensive issue that may have substantial economic burden and may lead to increased diabetes related complications. Those who did not receive medications or laboratory tests that were consistent with ADA guidelines had significantly increased emergency healthcare utilization in the following year. These findings highlight the importance of careful monitoring of T2D.

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Keywords

Diabetes Care, Evidence Based Guidelines, Healthcare System, Adherence and Compliance

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