Abstract
Objective: To analyze the factors associated with type 2 diabetes mellitus (T2DM) “remission” in non-bariatric Medicare patients 65 years and older.Research Design and Methods: A retrospective cohort analysis of a Medicare Advantage health plan was conducted using administrative data. An individual was identified as T2DM if the individual had: ≥ 2 medical claims for T2DM coded 250.xx excluding type 1 diabetes; or ≥ 2 pharmacy claims related to T2DM; or ≥ 2 combined medical claims, pharmacy claims for T2DM in 12 months. A T2DM individual was in “remission” if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and hence is represented in quotation (as “remission”). 10,059 T2DM individuals were evaluated over a period of 8 years from 2008 to 2015. Cox proportional hazards was used to identify significant variables associated with T2DM “remission.”Results: 4.97% of patients studied met the definition of T2DM “remission” in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM “remission” that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females (p < 0.05).Conclusion: T2DM “remission” in Medicare patients 65 years and older is observed in a community setting in a small proportion of non-bariatric patients.
Highlights
Specialty section: This article was submitted to Diabetes, a section of the journal Frontiers in Public Health
After adjusting for covariates this study found a number of variables associated with type 2 diabetes mellitus (T2DM) “remission” that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race; presence of other chronic ischemic heart disease (IHD) and females (p < 0.05)
CKD rate in the current study was likely lower because individuals with “disability” and “end stage renal disease (ESRD)” as their initial reason for Medicare enrollment were excluded from the sample [19]; (d) individuals who had pharmacy claims related to drug and/or steroid induced diabetes were excluded (n = 3,436); (e) individuals with type 1 diabetes were identified using ICD codes and excluded because type 1 diabetes has a different etiology from T2DM (n = 25,535); (f) individuals who had T2DM related diagnostics codes only during inpatient hospital stay and did not have T2DM diagnostic claims or T2DM related pharmacy claims in a non-hospital setting were excluded to account for potential surgery induced dysglycemia (n = 1,772); g) certain groups with contractual restrictions with the health plan prohibiting research (n = 2,238)
Summary
To analyze the factors associated with type 2 diabetes mellitus (T2DM) “remission” in non-bariatric Medicare patients 65 years and older. A T2DM individual was in “remission” if they had no T2DM related claims for more than 12 months continuously. This is different from the standard American Diabetes Association (ADA) definition of remission which includes HbA1c values and is represented in quotation (as “remission”). Results: 4.97% of patients studied met the definition of T2DM “remission” in the study cohort. After adjusting for covariates this study found a number of variables associated with T2DM “remission” that were not previously reported: no statin use; low diabetes complications severity index score; no hypertension; no neuropathy; no retinopathy; race (non-white and non-African American); presence of other chronic ischemic heart disease (IHD) and females (p < 0.05)
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