Tangelloju Srikanth, Little Bert B, Esterhay Robert J, Brock Guy, LaJoie A Scott
Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, United States.
Ohio State University Wexner Medical Center, Columbus, OH, United States.
Front Public Health. 2019 Apr 12;7:82. doi: 10.3389/fpubh.2019.00082. eCollection 2019.
To analyze the factors associated with type 2 diabetes mellitus (T2DM) "remission" in non-bariatric Medicare patients 65 years and older. A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in "remission" if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and hence is represented in quotation (as "remission"). 10,059 T2DM individuals were evaluated over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM "remission." 4.97% of patients studied met the definition of T2DM "remission" in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM "remission" that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females ( < 0.05). T2DM "remission" in Medicare patients 65 years and older is observed in a community setting in a small proportion of non-bariatric patients.
分析65岁及以上非肥胖型医疗保险患者2型糖尿病（T2DM）“缓解”的相关因素。利用管理数据对一项医疗保险优势健康计划进行回顾性队列分析。若个体符合以下条件，则被认定为患有T2DM：≥2次诊断为250.xx编码的T2DM医疗理赔记录（不包括1型糖尿病）；或≥2次与T2DM相关的药房理赔记录；或在12个月内≥2次T2DM的综合医疗理赔记录和药房理赔记录。若T2DM个体连续12个月以上无T2DM相关理赔记录，则处于“缓解”状态。这与美国糖尿病协会（ADA）的标准缓解定义不同，后者包括糖化血红蛋白（HbA1c）值，因此这里用引号表示为“缓解”。在2008年至2015年的8年时间里，对10,059名T2DM个体进行了评估。采用Cox比例风险模型来确定与T2DM“缓解”相关的显著变量。在研究队列中，4.97%的研究患者符合T2DM“缓解”的定义。在对协变量进行调整后，本研究发现了一些与T2DM“缓解”相关但此前未被报道的变量：未使用他汀类药物；糖尿病并发症严重程度指数得分低；无高血压；无神经病变；无视网膜病变；种族（非白人和非非裔美国人）；存在其他慢性缺血性心脏病（IHD）以及女性（P<0.05）。在社区环境中，一小部分非肥胖型65岁及以上医疗保险患者出现了T2DM“缓解”的情况。
