Effect of inadequate care on diabetes complications and healthcare resource utilization during management of type 2 diabetes in the United States

ABSTRACT

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

KEYWORDS:

• Type 2 diabetes mellitus
• quality of diabetes care
• evidence based guidelines
• health outcomes
• adherence to guidelines
• diabetes complications

Disclosure of any financial/other competing interests

The authors have no relevant conflicts of interest to disclose. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

CRediT authorship contribution statement

Benjamin Lewing: Conceptualization, Formal analysis, Investigation, Methodology, Project

administration, Writing – original draft, Writing – review & editing.

Shubhada Sansgiry: Methodology, Writing – review & editing.

Susan M. Abughosh: Methodology, Writing – review & editing.

Lincy S. Lal: Methodology, Writing – review & editing.

E. James Essien: Methodology, Writing – review & editing.

Sujit S. Sansgiry: Conceptualization, Supervision, Writing – review & editing.

Ethical statement

This project was approved by the University of Houston Institutional Review Board under the exempt category.

Additional information

Funding

No funding was received for the production of this manuscript.