Department of Pharmaceutical Health Outcomes and Policy, University of Houston, College of Pharmacy, Houston, TX, USA.
DeBakey Veterans Affairs Medical Center, Baylor College of MedicineCenter for Innovations in Quality, Effectiveness and Safety; Michael E. , Houston, TX, USA.
Postgrad Med. 2022 Jun;134(5):494-506. doi: 10.1080/00325481.2022.2061260. Epub 2022 Apr 12.
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.
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.
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.
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.
利用综合患者、医生和医疗系统因素的模型，评估 2 型糖尿病（T2D）治疗不足对健康结果的影响。
使用最新（2016-2018 年）的医疗支出面板调查纵向数据，确定接受过 2 型糖尿病治疗不足的成年人。采用美国糖尿病协会糖尿病标准来定义治疗不足，分为五个类别：生活方式管理、免疫接种、药物治疗、体检和实验室评估。对于每个五个类别，采用倾向评分 1:1 匹配来匹配接受不足治疗的个体和未接受不足治疗的个体。匹配后，对队列进行为期一年的随访。通过基线时总医疗保健支出变化、基线时总急诊医疗就诊变化、新发生的糖尿病相关并发症总数以及总缺勤天数变化来比较队列。
共有 1619 名患有 T2D 的成年人符合研究纳入标准，代表了 15781346 人，其中分别有 22.60%、22.80%、49.21%、23%和 23.45%接受了不足的生活方式管理、免疫接种、药物治疗、体检和实验室检查。在进行倾向评分匹配后，接受不足治疗的个体在接下来的一年中总医疗保健支出变化更大，新发生的糖尿病相关并发症更多。在调整了残余协变量不平衡后，接受不足药物治疗的个体急诊就诊次数增加了约 0.20 次，新发生的糖尿病相关并发症增加了 0.10 次。接受不足实验室检查的个体急诊就诊次数增加了 0.26 次。
2 型糖尿病治疗不足是一个广泛存在的问题，可能会带来巨大的经济负担，并可能导致糖尿病相关并发症的增加。那些没有接受符合 ADA 指南的药物治疗或实验室检查的患者，在接下来的一年中急诊就诊的次数显著增加。这些发现强调了仔细监测 T2D 的重要性。
