Abstract
BackgroundDiabetic nephropathy requires periodic monitoring, dietary modification, and early intervention to prevent the disease severity within limited resource settings. To emphasize the importance of continuous care for chronic diseases, various studies have focused on the association between continuity of care (COC) and common adverse outcomes. However, studies aimed at understanding the effect of COC on the incidence of chronic diseases, such as end-stage renal disease (ESRD), are few. The aim of this study was to determine whether there is an association between COC and the incidence of ESRD among patients with diabetic nephropathy. Moreover, we identified individual- and hospital-level factors associated with the incidence of ESRD among diabetic nephropathy patients.MethodsWe conducted a retrospective cohort study using the administrative National Health Insurance claims data from 2005 to 2012 in the Republic of Korea. The dependent variable, a binary variable, was the incidence of ESRD due to diabetic renal complication. In addition, using the COC index as a binary variable with a cutoff point of 0.75, we divided patients into a ‘Good COC group’ (COC index≥0.75) and a ‘Bad COC group’ (COC index< 0.75). The survival analysis was performed using the Cox proportional hazards models.ResultsAmong 3565 diabetic renal complication patients, ESRD occurred among 83 diabetes mellitus patients (2.3%). Nephropathy patients with lower COC level (< 0.75) had 1.99 times higher risk of ESRD incidence (95% confidence interval [CI]:1.27–3.12). In addition, the lowest income level patients had higher hazard ratio (HR) of ESRD than the highest income level patients (HR: 1.69 95% CI: 0.95–2.98), while patients with disabilities had 2.70 higher HR of ESRD than patients without disabilities (95% CI: 0.64–43).ConclusionsAmong patients with diabetic renal complication, higher continuity of care was associated with lower risk of ESRD. It is therefore recommended that continuous follow-up be encouraged to prevent ESRD among diabetic renal complication patients. Moreover, disparities in health outcomes between socially vulnerable groups including patients with disabilities and those in the lowest income level should be addressed.
Highlights
Diabetic nephropathy requires periodic monitoring, dietary modification, and early intervention to prevent the disease severity within limited resource settings
Because we focused on the continuity of ambulatory care for 8 years among surviving diabetic nephropathy patients, and observed the incidence of end-stage renal disease (ESRD) from 2005 to 2013, we excluded 47 patients who died during this period
During the 8-year follow-up from 2005 to 2012, 83 patients were diagnosed with ESRD with a mean ± standard deviation (SD) continuity of care (COC) level of 0.398 ± 0.492
Summary
Diabetic nephropathy requires periodic monitoring, dietary modification, and early intervention to prevent the disease severity within limited resource settings. Studies aimed at understanding the effect of COC on the incidence of chronic diseases, such as end-stage renal disease (ESRD), are few. The aim of this study was to determine whether there is an association between COC and the incidence of ESRD among patients with diabetic nephropathy. In Korea, the number of patients with diabetes increased by 24.6% from 2010 to 2015, and among them, approximately 5.8% were diagnosed with diabetic renal complication [3, 4]. These diabetic complications need periodic monitoring, dietary modification, and early intervention. COC and management of the physician-patient relationship should be reinforced in the early stages of the disease condition for a more effective management of diabetes [19]
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