Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, 4849 Calhoun Rd, Health and Biomedical Sciences Building 2 - Office 4055, Houston, TX 77204. Email:
Am J Manag Care. 2023 Jun 1;29(6):e176-e183. doi: 10.37765/ajmc.2023.89376.
To evaluate the effect of nonadherence to American Diabetes Association (ADA) guidelines on health care expenditures for patients with type 2 diabetes (T2D).
Retrospective cross-sectional cohort design, utilizing 2016-2018 Medical Expenditure Panel Survey data.
Patients with a diagnosis of T2D who completed the supplemental T2D care survey were included in the study. Participants were categorized based on adherence to the 10 processes in the ADA guidelines into adherent (≥ 9 processes) and nonadherent (≤ 6 processes) categories. Propensity score matching was employed using a logistic regression model. After matching, total annual health care expenditure change from baseline year was compared using a t test. Further, imbalanced variables were controlled for in a multivariable linear regression model.
A total of 1619 patients representing 15,781,346 (SE = 438,832) individuals met the inclusion criteria, among whom 12.17% received nonadherent care. After propensity matching, those who received nonadherent care had $4031 higher total annual health care expenditures compared with their baseline year, whereas patients who received adherent care had $128 lower total annual health care expenditures compared with their baseline year. Further, multivariable linear regression adjusted for the imbalanced variables indicated that nonadherent care was associated with a mean (SE) $3470 ($1588) increase in the change from baseline health care expenditure.
Nonadherence to the ADA guidelines results in a significant increase in health care expenditures among patients with diabetes. The economic impact of nonadherent care for T2D is a significant and extensive issue that needs to be addressed. These findings emphasize the importance of providing care based on ADA guidelines.
评估不遵守美国糖尿病协会（ADA）指南对 2 型糖尿病（T2D）患者医疗支出的影响。
利用 2016-2018 年医疗支出面板调查数据进行回顾性横截面队列设计。
纳入完成 T2D 补充护理调查的 T2D 患者。参与者根据 ADA 指南中的 10 项流程的依从性分为依从性（≥9 项流程）和不依从性（≤6 项流程）类别。采用逻辑回归模型进行倾向评分匹配。匹配后，使用 t 检验比较从基线年开始的总年度医疗保健支出变化。此外，在多变量线性回归模型中控制了不平衡变量。
共有 1619 名患者（代表 15781346 人，SE=438832）符合纳入标准，其中 12.17%接受不依从护理。在倾向评分匹配后，接受不依从护理的患者总年度医疗保健支出比基线年高出 4031 美元，而接受依从护理的患者总年度医疗保健支出比基线年低 128 美元。此外，调整了不平衡变量的多变量线性回归表明，不依从护理与基线医疗保健支出变化的平均（SE）增加 3470 美元（1588 美元）相关。
不遵守 ADA 指南会导致糖尿病患者的医疗支出显著增加。T2D 不依从护理的经济影响是一个重大而广泛的问题，需要加以解决。这些发现强调了根据 ADA 指南提供护理的重要性。
