TY - JOUR
T1 - Evolution of Clinical Complexity, Treatment Burden, Health Care Use, and Diabetes-Related Outcomes Among Commercial and Medicare Advantage Plan Beneficiaries With Diabetes in the U.S., 2006–2018
AU - Benning, Tyler J.
AU - Heien, Herbert C.
AU - McCoy, Rozalina G.
N1 - Funding Information:
This effort was funded by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), grant K23DK114497. In the last 36 months, R.G.M. has received support from NIDDK, the Patient-Centered Outcomes Research Institute, and AARP. Study contents are the sole responsibility of the authors and do not necessarily represent the official views of NIH.
Funding Information:
Funding. This effort was funded by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), grant K23DK114497. In the last 36 months, R.G.M. has received support from NIDDK, the Patient-Centered Outcomes Research Institute, and AARP.
Publisher Copyright:
© 2022 by the American Diabetes Association.
PY - 2022/10
Y1 - 2022/10
N2 - OBJECTIVE To characterize trends in clinical complexity, treatment burden, health care use, and diabetes-related outcomes among adults with diabetes. RESEARCH DESIGN AND METHODS We used a nationwide claims database to identify enrollees in commercial and Medicare Advantage plans who met claims criteria for diabetes between 1 January 2006 and 31 March 2019 and to quantify annual trends in clinical complexity (e.g., active health conditions), treatment burden (e.g., medications), health care use (e.g., ambu-latory, emergency department [ED], and hospital visits), and diabetes-related outcomes (e.g., hemoglobin A1c [HbA1c] levels) between 2006 and 2018. RESULTS Among 1,470,799 commercially insured patients, the proportion with ‡10 active health conditions increased from 33.3% (95% CI 33.1–33.4) in 2006 to 38.9% (38.8–39.1) in 2018 (P = 0.001) and the proportion taking three or more glucose-lowering medications increased from 11.6% (11.5–11.7) to 23.1% (22.9–23.2) (P = 0.007). The proportion with HbA1c ‡8.0% (‡64 mmol/mol) increased from 28.0% (27.7–28.3) in 2006 to 30.5% (30.2–30.7) in 2015, decreasing to 27.8% (27.5–28.0) in 2018 (overall trend P = 0.04). Number of ambulatory visits per patient per year de-creased from 6.86 (6.84–6.88) to 6.19 (6.17–6.21), (P = 0.001) while ED visits increased from 0.26 (0.257–0.263) to 0.29 (0.287–0.293) (P = 0.001). Among 1,311,903 Medicare Advantage enrollees, the proportion with ‡10 active conditions increased from 51.6% (51.2–52.0) to 65.1% (65.0–65.2) (P < 0.001); the proportion taking three or more glucose-lowering medications was stable at 16.6% (16.3–16.9) and 18.1% (18.0–18.2) (P = 0.98), and the proportion with HbA1c ‡8.0% increased from 17.4% (16.7–18.1) to 18.6% (18.4–18.7) (P = 0.008). Ambulatory visits per patient per year remained stable at 8.01 (7.96–8.06) and 8.17 (8.16–8.19) (P = 0.23), but ED visits increased from 0.41 (0.40–0.42) to 0.66 (0.66–0.66) (P < 0.001). CONCLUSIONS Among patients with diabetes, clinical complexity and treatment burden have increased over time. ED utilization has also increased, and patients may be using ED services for low-acuity conditions.
AB - OBJECTIVE To characterize trends in clinical complexity, treatment burden, health care use, and diabetes-related outcomes among adults with diabetes. RESEARCH DESIGN AND METHODS We used a nationwide claims database to identify enrollees in commercial and Medicare Advantage plans who met claims criteria for diabetes between 1 January 2006 and 31 March 2019 and to quantify annual trends in clinical complexity (e.g., active health conditions), treatment burden (e.g., medications), health care use (e.g., ambu-latory, emergency department [ED], and hospital visits), and diabetes-related outcomes (e.g., hemoglobin A1c [HbA1c] levels) between 2006 and 2018. RESULTS Among 1,470,799 commercially insured patients, the proportion with ‡10 active health conditions increased from 33.3% (95% CI 33.1–33.4) in 2006 to 38.9% (38.8–39.1) in 2018 (P = 0.001) and the proportion taking three or more glucose-lowering medications increased from 11.6% (11.5–11.7) to 23.1% (22.9–23.2) (P = 0.007). The proportion with HbA1c ‡8.0% (‡64 mmol/mol) increased from 28.0% (27.7–28.3) in 2006 to 30.5% (30.2–30.7) in 2015, decreasing to 27.8% (27.5–28.0) in 2018 (overall trend P = 0.04). Number of ambulatory visits per patient per year de-creased from 6.86 (6.84–6.88) to 6.19 (6.17–6.21), (P = 0.001) while ED visits increased from 0.26 (0.257–0.263) to 0.29 (0.287–0.293) (P = 0.001). Among 1,311,903 Medicare Advantage enrollees, the proportion with ‡10 active conditions increased from 51.6% (51.2–52.0) to 65.1% (65.0–65.2) (P < 0.001); the proportion taking three or more glucose-lowering medications was stable at 16.6% (16.3–16.9) and 18.1% (18.0–18.2) (P = 0.98), and the proportion with HbA1c ‡8.0% increased from 17.4% (16.7–18.1) to 18.6% (18.4–18.7) (P = 0.008). Ambulatory visits per patient per year remained stable at 8.01 (7.96–8.06) and 8.17 (8.16–8.19) (P = 0.23), but ED visits increased from 0.41 (0.40–0.42) to 0.66 (0.66–0.66) (P < 0.001). CONCLUSIONS Among patients with diabetes, clinical complexity and treatment burden have increased over time. ED utilization has also increased, and patients may be using ED services for low-acuity conditions.
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U2 - 10.2337/dc21-2623
DO - 10.2337/dc21-2623
M3 - Article
C2 - 35926104
AN - SCOPUS:85139374139
SN - 0149-5992
VL - 45
SP - 2299
EP - 2308
JO - Diabetes care
JF - Diabetes care
IS - 10
ER -