Lee Wei-Chen, Digbeu Biai Dominique Elmir, Sallam Hanaa S, Serag Hani, Kuo Yong-Fang
The University of Texas Medical Branch at Galveston, Galveston, USA.
J Cancer Surviv. 2025 Apr;19(2):534-544. doi: 10.1007/s11764-023-01487-x. Epub 2023 Nov 24.
This study aimed to examine the impact of utilization of the Medicare-covered Diabetes Self-Management Training (DSMT) on the likelihood of receiving preventive care and on outcomes among cancer survivors with diabetes.
We conducted a retrospective cohort study using 1999-2019 Texas Cancer Registry-Medicare linkage data for beneficiaries diagnosed with prostate, colorectal, or breast cancer for ≥5 years. We used propensity score matching to estimate the beneficiaries' probability of receiving DSMT and matched it with non-users. The observed DSMT outcomes were hospitalization, ER visit, eye exam, HbA1c test, foot exam, nephropathy, and all-cause mortality. DSMT utilization was set at attending 1, 2, and 3 or more sessions. Conditional Cox proportional hazard regression was built to determine the association between DSMT use and each respective outcome, unadjusted and adjusted for patients' covariates.
A total of 79,271 beneficiaries (65% had diabetes-related complications, and 41% were either prostate or breast cancer survivors) were included. We found that (1) DSMT users had more eye exams (HR=1.27), HbA1c tests (HR=1.47), foot exams (HR=1.21), and nephropathy visits (HR=1.11), and less hospitalization (HR=0.86) and overall mortality (HR=0.70) (p≤0.01 each vs. non-users); (2) among DSMT users, 56% attended one session, 24% attended 2 sessions, and 20% attended 3 or more sessions; (3) attending 2 or ≥3 DSMT sessions was associated with more eye exams (HR=1.14), HbA1c tests (HR=1.12), and foot exams (HR=1.24).
DSMT is instrumental to preventing or delaying complications of diabetes in cancer survivors and reducing their overall mortality. The findings may inform future efforts to promote the value of DSMT for cancer survivors.
Medicare-covered DSMT offers a great value to cancer survivors with diabetes.
本研究旨在探讨利用医疗保险覆盖的糖尿病自我管理培训（DSMT）对癌症幸存者糖尿病患者接受预防性护理的可能性及预后的影响。
我们进行了一项回顾性队列研究，使用1999 - 2019年德克萨斯癌症登记处与医疗保险的关联数据，研究对象为被诊断患有前列腺癌、结直肠癌或乳腺癌≥5年的受益人。我们使用倾向得分匹配法来估计受益人接受DSMT的概率，并将其与未使用者进行匹配。观察到的DSMT结果包括住院、急诊就诊、眼科检查、糖化血红蛋白（HbA1c）检测、足部检查、肾病以及全因死亡率。DSMT的使用情况设定为参加1次、2次以及3次或更多次课程。构建条件Cox比例风险回归模型以确定DSMT使用与各相应结果之间的关联，未调整以及针对患者协变量进行调整。
共纳入79,271名受益人（65%患有糖尿病相关并发症，41%为前列腺癌或乳腺癌幸存者）。我们发现：（1）DSMT使用者进行眼科检查（风险比[HR]=1.27）、HbA1c检测（HR=1.47）、足部检查（HR=1.21）和肾病就诊（HR=1.11）的次数更多，住院（HR=0.86）和总体死亡率（HR=0.70）更低（与未使用者相比，每项p≤0.01）；（2）在DSMT使用者中，56%参加了1次课程，24%参加了2次课程，20%参加了3次或更多次课程；（3）参加2次或≥3次DSMT课程与更多的眼科检查（HR=1.14）、HbA1c检测（HR=1.12）和足部检查（HR=1.24）相关。
DSMT有助于预防或延缓癌症幸存者糖尿病的并发症并降低其总体死亡率。这些发现可能为未来促进DSMT对癌症幸存者的价值的努力提供参考。
医疗保险覆盖的DSMT对患有糖尿病的癌症幸存者具有很大价值。
