In 2017-2018, only one in three adults with diabetes in the U.S. received five basic items of care recommended by the American Diabetes Association (ADA), according to new research.
The proportions of patients who visited a doctor to receive diabetes care and received them A1c testing, foot and eye exams, and cholesterol testing increased from 2005 to 2018. However, this increase occurred primarily between age 65 and older and therefore eligible for Medicare.
“Our study suggests that providing affordable medical coverage can help ensure that people with diabetes receive recommended care. We also found that patients who did not receive recommended care were more likely to be younger, newly diagnosed with “Diabetes and not diabetes medications. Clinicians can pay more attention to these patient populations to improve recommended care and prevent diabetes-related complications,” said author Jung-Im Shin, MD Medscape Medical News.
The data predate the COVID-19 pandemic, which it has also had major effects on the treatment of diabetes, added Shin, of the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
“Routine visits to the doctor and important tests for retinopathy or foot examination have been postponed. People with diabetes have had to reschedule or cancel non-urgent visits, some have lost … unemployment insurance and many have avoided health centers for fear “We are just beginning to understand the consequences of the pandemic on the health of people with diabetes,” Shin notes.
Overall improvements are only seen among those over 65
The data, from 4069 adults aged 20 and over from the National Health and Nutrition Survey (NHANES) 2005-2018, were published online April 16 a Diabetes care.
Shin and colleagues defined the reception of diabetes care as meeting the following five criteria in the last twelve months, based on ADA care standards and availability of NHANES data: consult a primary care physician for diabetes care; receive A1c tests; receive a foot exam; receive an eye exam; and receive cholesterol tests.
Throughout the 13-year period, 29.2% of respondents said they had received all five components.
This proportion increased significantly over time, from 25.0% in 2005-2006 to 34.1% in 2017-2018 (Pgtrend = .004). However, among the individual components, only A1c tests increased significantly over time, from 64.4% to 85.3%, in all age groups (Pgtrend <.001).
In addition, when stratified by age, the reception of the five components only increased significantly among participants aged 65 years or older, from 29.3% in 2005-2006 to 44.2% in 2017-2018 (Pgtrend = .001).
The proportion remained unchanged among those aged 40 to 64 (from 25.2% to 25.8%); Pgtrend = .457) and showed a non-significant increase in those aged 20 to 39 years (from 9.9% to 26.0%; Pgtrend = .401).
In tight analyzes, old age, higher income and education, health insurance, longer duration of diabetes, use of anti-diabetic drugs and hypercholesterolemia were significantly associated with the reception of diabetic care recommended by the ADA guidelines.
Factors not associated with the care receipt included sex, race / ethnicity, body mass index, smoking status, A1c, hypertension, cardiovascular disease, chronic kidney disease, and depressive symptoms.
Participants who received recommended care under the ADA guidelines were significantly more likely to achieve A1c below 7.5% (adjusted probability, 1.52), blood pressure below 140/90 mmHg (1.47), and LDL cholesterol. less than 100 mg / dL (1.47), and to receive cholesterol-lowering medications (1.79).
Shin said Medscape Medical News that it will be “important to study the impact of COVID-19 on diabetes care when new data become available.”
The project was supported by a Merck research grant from the Johns Hopkins Bloomberg School of Public Health. Shin has reportedly received a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. Two co-authors are Merck employees.
Diabetes care. Published online April 16, 2021. Summary
Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diabetes Forecast magazine. He is on Twitter: @MiriamETucker.