The quality of diabetic care in patients with cancer.

Abstract

e19547 Background: Diabetes, a common comorbidity in cancer patients, has been associated with higher overall and cancer specific mortality. Suboptimal diabetic care among cancer patients may be at least partially contributing to this excess mortality. Methods: Using the National Health and Nutrition Examination Survey (NHANES 1999-2006) we compared the quality of diabetic care in diabetic cancer survivors to adults with diabetes but no history of cancer. Quality of care was assessed using the National Diabetic Quality Improvement Alliance criteria (HbA1C, blood pressure, cholesterol, frequency of screening tests). Suboptimal care was defined as having 3 or more quality indicators that were not achieved. Results: 228 survivors, and 882 age and sex matched controls were identified. There was no significant difference in the individual quality indicators between survivors and controls, nor in the proportion receiving suboptimal care (27.8 v 31.7%). The majority of participants attained the targets for HbA1C (82.4 v. 81.7%), and reported routine blood pressure and cholesterol screening (92.1 v 95.8% and 78.8 v 83.7%). A lower percentage of patients in both groups had ideal blood pressure (57.3 v 53.9%) or cholesterol (60.3 v 53.9%) control. Among survivors, insurance status and cancer type were significantly associated with the likelihood of suboptimal care. Compared to privately insured patients, those with no health insurance were more likely to receive suboptimal care (OR 4.2), while those with Medicare coverage were less likely to receive suboptimal care (OR 0.59). Compared with breast cancer patients, those with a history of colon (OR 2.7) or gynecological cancer (OR 3.8) were more likely to receive suboptimal care. There was no significant association between likelihood of suboptimal care and age, income, race or comorbidities. Conclusions: There was no significant difference in the quality of diabetic care received by survivors compared with controls, but the quality of care could be improved for all diabetic patients. Among survivors, those with a history of gynaecological or colon cancer, and those without health insurance represent groups at highest risk of suboptimal diabetic care and serve as potential target groups for quality care initiatives. No significant financial relationships to disclose.