In 2017-2018, only one in three adults in the United States with diabetes received five basic elements of primary care recommended by the American Diabetes Association (ADA).
The proportion of patients who consulted a doctor for diabetes care and received A1c tests, foot and eye exams, and cholesterol tests increased from 2005 to 2018. However, this increase was mainly seen in patients 65 years of age and older and therefore Medicare-eligible.
“Our study suggests that affordable health insurance can help people with diabetes receive recommended care. We also found that patients who do not receive recommended care are more likely to be younger and newly diagnosed with diabetes than not Clinicians can pay more attention to these patient populations to improve recommended care and prevent diabetes-related complications, “senior author Jung-Im Shin, MD, told Medscape Medical News.
The data is from before the COVID-19 pandemic, which also had a significant impact on the delivery of diabetes, added Shin of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
“Routine visits to the doctor and important checkups for retinopathy or foot exams have been postponed. People with diabetes have not had to postpone or cancel urgent visits, some have lost insurance after unemployment … and many have shunned healthcare facilities for fear of we’re just beginning to face the consequences of Understanding pandemic for the health of people with diabetes, “notes Shin.
General improvements only for people aged 65 and over
Data from 4,069 adults ages 20 and up from the National Health and Nutrition and Examination Survey (NHANES) 2005-2018 was published online in Diabetes Care on April 16.
Shin and colleagues defined receipt of diabetes care as meeting all of the following five criteria in the past 12 months, based on ADA standards for care and availability of NHANES data: seeing a family doctor for diabetes care; Receiving A1c tests; get a foot exam; get an eye exam; and get cholesterol tests.
Over the entire 13-year period, 29.2% of those surveyed stated that they had received all five components.
This proportion increased significantly over time from 25.0% in 2005-2006 to 34.1% in 2017-2018 (Ptrend = 0.004). Among the individual components, however, only the A1c test increased significantly over time in all age groups from 64.4% to 85.3% (Ptrend <0.001).
In addition, the maintenance of all five components, stratified by age, only increased significantly for participants aged 65 and over from 29.3% in 2005-2006 to 44.2% in 2017-2018 (Ptrend = 0.001).
The proportion remained unchanged among 40 to 64 year olds (25.2% to 25.8%; Ptrend = 0.457) and showed an insignificant increase among 20 to 39 year olds (9.9% to 26.0) %; Ptrend = 0.401).
In custom analyzes, age, higher income and education, health insurance, longer duration of diabetes, use of diabetes medication, and hypercholesterolemia were all significantly linked to receiving ADA recommended diabetes care.
Factors not associated with receiving care included gender, race / ethnicity, body mass index, smoking status, A1c, high blood pressure, cardiovascular disease, chronic kidney disease, and depressive symptoms.
Participants who received treatment recommended by ADA were significantly more likely to have A1c below 7.5% (adjusted odds ratio, 1.52), blood pressure less than 140/90 mmHg (1.47), and LDL cholesterol below 100 mg / dl (1.47). and receiving cholesterol lowering drugs (1.79).
Shin told Medscape Medical News that it “will be important to study the impact of COVID-19 on diabetes care when new data becomes available”.
The project was supported by a research grant from Merck to the Johns Hopkins Bloomberg School of Public Health. Shin reported receiving a grant from the National Institute for Diabetes and Digestive and Kidney Diseases. Two co-authors are Merck employees.
Diabetes treatment. Published online April 16, 2021. Executive summary
Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape. Additional work appears in the Washington Post, NPR blog Shots, and Diabetes Forecast magazine. She’s on Twitter: @MiriamETucker.
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