Association between continuity of care and type 2 diabetes development among patients with thyroid disorder.

Sang Ah Lee,Junhyun Kwon,Eun-Cheol Park,Dong-Woo Choi,Doo Woong Lee

doi:10.1097/md.0000000000018537

Abstract

Thyroid disorders are associated with blood glucose abnormalities. For rendering the patients euthyroid, routine screening and care are essential. Therefore, the aim of this study was to investigate the association between continuity of care (COC) and type 2 diabetes onset among patients with thyroid disorders.We used the national claim data. Our study population was 4099 patients with hyperthyroidism or hypothyroidism. For calculating COC, the Most Frequent Provider Continuity Index (MFPCI), Modified Modified Continuity Index (MMCI), and COC Index (COCI) were used. The dependent variable was type 2 diabetes onset. The Cox proportional hazard regression model was used.Among 4099 patients with thyroid disorders, 25.3% experienced onset of type 2 diabetes. Thyroid patients who had MFPCI and COCI below the median were more likely to experience onset of type 2 diabetes than who had these indices above the median (MFPCI: hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.09–1.46; COCI: HR = 1.22, 95% CI = 1.06–1.41). Our subgroup analysis showed that female patients and those 20 to 34 years of age showed a significant association between COC and onset of type 2 diabetes.Patients with thyroid disorders with low COC showed an increased risk of developing type 2 diabetes. Therefore, efforts to enhance COC among patients with thyroid disorders needs to be encouraged.

Highlights

Thyroid dysfunction is one of the most prevalent endocrine disorders.[1]
The mean Most Frequent Provider Continuity Index (MFPCI), Modified Modified Continuity Index (MMCI), and COC Index (COCI) were 0.897 ± 0.165, 0.940 ± 0.105, and 0.842 ± 0.235, respectively. Among those whose MFPCI, MMCI, and COCI were less than the median, 29.3% (n = 250), 27.3% (n = 330), and 28.9% (n = 330) experienced type 2 diabetes (T2D), respectively
Thyroid patients with their MFPCI and COCI less than the median were more likely to experience an onset of T2D than were those with values exceeding the median (MFPCI: hazard ratios (HRs) = 1.26, 95% CI = 1.09–1.46; COCI: HR = 1.22, 95% CI = 1.06–1.41)

Summary

Introduction

Thyroid dysfunction is one of the most prevalent endocrine disorders.[1] According to the American Association of Clinical Endocrinologists, an estimated 13 million people, representing 4.8% of the population of the United States, have undiagnosed thyroid dysfunction.[2] The prevalence of thyroid dysfunction is on the rise in South Korea. According to the Health Insurance Review and Assessment Service, the number of people with thyroid dysfunction has increased from 914,000 in 2009 to Editor: Daryle Wane. A Department of Public Health, Graduate School, b Institute of Health Services Research, Yonsei University, Seoul, c Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, d Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea. Association between continuity of care and type 2 diabetes development among patients with thyroid disorder.

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