Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine.
Division of Preventive Medicine, University of Alabama at Birmingham, 1717 11th Ave South, MT-616, Birmingham, AL 35205 (
Prev Chronic Dis. 2023 Sep 14;20:E81. doi: 10.5888/pcd20.220332.
Despite advances in diabetes management, only one-quarter of people with diabetes in the US achieve optimal targets for glycated hemoglobin A (HbA), blood pressure, and cholesterol. We sought to evaluate temporal trends and predictors of achieving glycemic control among adults with type 2 diabetes covered by Alabama Medicaid from 2011 through 2019.
We completed a retrospective analysis of Medicaid claims and laboratory data, using person-years as the unit of analysis. Inclusion criteria were being aged 19 to 64 years, having a diabetes diagnosis, being continuously enrolled in Medicaid for a calendar year and preceding 12 months, and having at least 1 HbA result during the study year. Primary outcomes were HbA thresholds of <7% and <8%. Primary exposure was study year. We conducted separate multivariable-adjusted logistic regressions to evaluate relationships between study year and HbA thresholds.
We included 43,997 person-year observations. Mean (SD) age was 51.0 (9.9) years; 69.4% were women; 48.1% were Black, 42.9% White, and 0.4% Hispanic. Overall, 49.1% had an HbA level of <7% and 64.6% <8%. Later study years and poverty-based eligibility were associated with lower probability of reaching target HbA levels of <7% or <8%. Sex, race, ethnicity, and geography were not associated with likelihood of reaching HbA <7% or <8% in any model.
Later study years were associated with lower likelihood of meeting target HbA levels compared with 2011, after adjusting for covariates. With approximately 35% not meeting an HbA target of <8%, more work is needed to improve outcomes of low-income adults with type 2 diabetes.
尽管糖尿病管理取得了进步，但美国只有四分之一的糖尿病患者的糖化血红蛋白 A（HbA）、血压和胆固醇达到最佳目标。我们试图评估 2011 年至 2019 年期间，参加阿拉巴马州医疗补助计划的 2 型糖尿病成年人实现血糖控制的时间趋势和预测因素。
我们使用人年作为分析单位，对医疗补助索赔和实验室数据进行回顾性分析。纳入标准为年龄 19 至 64 岁，有糖尿病诊断，在日历年内连续参加医疗补助计划并在前 12 个月内持续参加，且在研究年内至少有 1 次 HbA 结果。主要结局是 HbA 阈值<7%和<8%。主要暴露是研究年。我们分别进行多变量调整后的逻辑回归，以评估研究年与 HbA 阈值之间的关系。
我们纳入了 43997 个人年观察值。平均（标准差）年龄为 51.0（9.9）岁；69.4%为女性；48.1%为黑人，42.9%为白人，0.4%为西班牙裔。总体而言，49.1%的人 HbA 水平<7%，64.6%的人 HbA 水平<8%。较晚的研究年份和基于贫困的资格与达到目标 HbA 水平<7%或<8%的可能性较低相关。在任何模型中，性别、种族、民族和地理位置均与达到 HbA<7%或<8%的可能性无关。
在调整了协变量后，与 2011 年相比，较晚的研究年份与达到目标 HbA 水平的可能性较低相关。大约 35%的人未达到 HbA<8%的目标，因此需要做更多的工作来改善低收入 2 型糖尿病成年患者的结局。
