Diabetes diagnosis and management among insured adults across metropolitan areas in the U.S.

Wenya Yang,Timothy M Dall,Ritashree Chakrabarti,F Ellen Loh,William Iacobucci,Eleonora Tan,Erin Byrne

doi:10.1016/j.pmedr.2018.03.014

Abstract

This study provides diabetes-related metrics for the 50 largest metropolitan areas in the U.S. in 2012—including prevalence of diagnosed and undiagnosed diabetes, insurance status of the population with diabetes, diabetes medication use, and prevalence of poorly controlled diabetes.Diabetes prevalence estimates were calculated using cross-sectional data combining the Behavioral Risk Factor Surveillance System, American Community Survey, National Nursing Home Survey, Census population files, and National Health and Nutrition Examination Survey. Analysis of medical claims files (2012 de-identified Normative Health Information database, 2011 Medicare Standard Analytical Files, and 2008 Medicaid Analytic eXtract) produced information on treatment and poorly controlled diabetes by geographic location, insurance type, sex, and age group.Among insured adults with diagnosed type 2 diabetes in 2012, the proportion receiving diabetes medications ranged from 83% in Oklahoma City, Oklahoma, to 65% in West Palm Beach, Florida. The proportion of treated patients with medical claims indicating poorly controlled diabetes was lowest in Minneapolis, Minnesota (36%) and highest in Texas metropolitan areas of Austin (51%), San Antonio (51%), and Houston (50%).Estimates of diabetes detection and management across metropolitan areas often differ from state and national estimates. Local metrics of diabetes management can be helpful for tracking improvements in communities over time.

Highlights

Diabetes is a major epidemic in the United States, yet many people with diabetes are undiagnosed, uninsured, or have suboptimal health or adherence outcomes (Centers for Disease Control and Prevention, 2014a, 2014b; Dall et al, 2016)
Insurance coverage and quality of care for people with diabetes were anticipated to improve with implementation of the Affordable Care Act (ACA), new U.S Preventive Services Task Force guidelines around screening and treatment, and evolving standards of care (US Preventive Services Task Force, 2015; American Diabetes Association, 2017)
Half (53%) of U.S adults resided in these Metropolitan Statistical Areas (MSAs), including 51% of diabetes patients and 55% of adults with undiagnosed diabetes cases (Table 1)

Summary

Introduction

Diabetes is a major epidemic in the United States, yet many people with diabetes are undiagnosed, uninsured, or have suboptimal health or adherence outcomes (Centers for Disease Control and Prevention, 2014a, 2014b; Dall et al, 2016). Select metrics of diabetes detection and management have been calculated for 2012 at the state and national levels (Dall et al, 2016; Centers for Disease Control and Prevention, 2014a, 2014b). About 92% of insured adults with diagnosed diabetes had type 2 diabetes, and many of these adults had suboptimal outcomes related to medication adherence, glycemic control, and presence of complications. Among insured type 2 patients receiving antidiabetic medications, the proportion with medical claims indicating poor diabetes control ranged from 53% in Texas to 29% in Minnesota and Iowa (Dall et al, 2016)

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Discussion

Conclusion