Diabetes Care Processes Research Articles

Associations between income/employment status and diabetes care processes, health behaviors, and health outcomes in Japan: A cross-sectional study using claims data linked to a questionnaire survey.

We aimed to explore the associations between income/employment status and diabetes care processes, health behaviors and health outcomes. This cross-sectional study used health insurance claims data between April 2021 and March 2022, and a questionnaire survey between December 2022 and January 2023 in Tsukuba City. The study analyzed the participants with diabetes (other than type 1) from those selected by stratified random sampling. We evaluated diabetes care processes, health behaviors and health outcomes by calculating weighted proportions among the groups. We also assessed the associations between income/employment status and these variables using multivariable modified Poisson regression models. Of the 264 identified participants, 161 (64.2%) were men and 168 (72.8%) were aged ≥65 years old. Compared with the low-income groups, the high-income group had a higher proportion of sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide-1 receptor agonists use (adjusted risk ratio [aRR] 1.70, 95% confidence interval (CI) 1.07-2.72), a higher proportion of attendance to annual health checkups for ≥2 years (aRR 1.68, 95% CI 1.07-2.64) and a lower proportion of all-cause hospitalization (aRR 0.15, 95% CI 0.04-0.48); additionally, the middle-income group had a lower proportion of high total outpatient medical expenses (aRR 0.57, 95% CI 0.35-0.92). Compared to the no work time group, the full-time work group had a lower proportion of exercise habits (aRR 0.59, 95% CI 0.35-0.99) and a higher proportion of good self-reported health (aRR 2.08, 95% CI 1.22-3.55). Several variables were associated with income/employment status. Policy intervention should focus on high-risk groups identified by considering these associations.

Disparities in diabetes processes of care among people experiencing homelessness: An opportunity for intervention

AimsTo compare processes of diabetes care by homeless status. MethodsA population-based propensity matched cohort study was conducted in Ontario, Canada. People with diabetes were identified in administrative healthcare data between April 2006 and March 2019. Those with a documented history of homelessness were matched to non-homeless controls. Data on processes of care measures included glucose monitoring tests, screening for microvascular complications, and physician follow-up. Differences in processes of care were compared by homeless status using proportions, risk ratios, and rate ratios. ResultsOf the 1,076,437 people with diabetes, 5219 matched pairs were identified. Homelessness was associated with fewer tests for glycated hemoglobin (RR = 0.63; 95 %CI: 0.60–0.67), LDL cholesterol (RR = 0.80; 95 %CI: 0.78–0.82), serum creatinine (RR = 0.94; 95 %CI: 0.92–0.97), urine protein quantification (RR = 0.62; 95 %CI: 0.59–0.66), and eye examinations (RR = 0.74; 95 %CI: 0.71–0.77). People with a history of homelessness were less likely to use primary care for diabetes management (RR = 0.62; 95 %CI: 0.59–0.66) or specialist care (RR = 0.87; 95 %CI: 0.83–0.91) compared to non-homeless controls. ConclusionsDisparities in diabetes care are evident for people with a history of homelessness and contribute to excess morbidity in this population. These data provide an impetus for investment in tailored interventions to improve healthcare equity and prevent long-term complications.

Disruption to routine diabetes care processes during the pandemic: evidence from a large integrated health system in the Southeast United States

IntroductionWe investigated the impact of the COVID-19 pandemic on annual adherence to seven diabetes care guidelines and risk factor management among people with diabetes.Research design and methodsWe included all adults...

Effectiveness of a diabetes program based on digital health on capacity building and quality of care in type 2 diabetes: a pragmatic quasi-experimental study

Health systems in Latin America face many challenges in controlling the increasing burden of diabetes. Digital health interventions are a promise for the provision of care, especially in developing countries where mobile technology has a high penetration. This study evaluated the effectiveness of the implementation of a Diabetes Program (DP) that included digital health interventions to improve the quality of care of persons with type 2 Diabetes (T2DM) in a vulnerable population attending the public primary care network.Materials and methodsA quasi-experimental pre-post uncontrolled study was conducted in 19 primary care centers and hospitals in the province of Corrientes, Argentina. We included persons with T2DM, age > = 18 years with access to a mobile phone. The multicomponent intervention included a mobile app with a diabetes registry, a clinical decision support tool for providers and a text messaging intervention for patients.Results and discussionOne thousand sixty-five participants were included, 72.8% had less than 12 years of formal education and 53.5% lacked health coverage. Comorbidities were hypertension (60.8%) and overweight/obesity (88.2%). During follow-up there was a significant increase in the proportion of participants who underwent laboratory check-ups (HbA1c 20.3%-64.4%; p < 0.01) and foot exams (62.1%-87.2%; p < 0.01). No changes were observed at 12 and 24 months in the proportion of participants with poor metabolic control. The proportion of participants with uncontrolled blood pressure (≥ 140/90 mmHg) decreased from 47.2% at baseline to 30.8% at 24 months in those with a follow-up visit.ConclusionThe DP was innovative by integrating digital health interventions in the public primary care level. The study showed improvements in quality indicators related with diabetes care processes and in blood pressure control.

Gender gaps in type 1 diabetes care.

Diabetes mellitus is one of the largest global health concerns of recent times. Women with diabetes mellitus have a higher excess risk of all-cause mortality and more vascular events than men. Focusing on type 1 diabetes, this could be caused by gender inequalities in delivered diabetes care. This study aims to assess gender differences in type 1 diabetes outpatient care, particularly diagnostics and outcomes. This cross-sectional cohort study included all adult type 1 diabetes patients in the Dutch Pediatric and Adult Registry of Diabetes (DPARD) visiting diabetes outpatient clinics between 2016-2021. The frequency of process measurements, including physical examination and laboratory testing, was assessed among both sexes after adjustment for age and body mass index. Gender differences in eGFR ≥ 60, BMI-, and control in blood pressure and LDL-cholesterol were evaluated. Hospital variation in achieving HbA1c targets of 53mmol/mol and median HbA1c were assessed. Cardiovascular risk scores were calculated in men and women using the Systematic Coronary Risk Evaluation (SCORE) European low-risk chart. Our study showed a 17% higher odds of reaching weight control and a 23% lower odds of achieving blood pressure targets in men than women. Gender-skewed cardiovascular mortality risk scores were found. Gender disparities in outcomes appear not to be caused by gender-biased attitudes in healthcare professionals since no gender differences were found in the performance of process measurements in type 1 diabetes care. In addition, hospitals appear to vary by extent of gender differences in achieving a target HbA1c of 53mmol/mol. Gender equality exists in the diagnostic process of diabetes care. However, differences in weight control, blood pressure control, and cardiovascular mortality risk scores remain between both sexes, most likely due to multifactorial causes. Indications for interhospital variation in gender disparities in HbA1c control exist. Further focus on performance of process measurements between hospitals may identify areas for improvement of gender-skewed outcomes to further enhance Dutch diabetes care for both sexes.

Literature Review: Effect of Brisk Walking on Blood Sugar Levels in Pa-tients with Type 2 Diabetes Mellitus

Diabetes is a chronic disease when the pancreas cannot produce enough insulin. Therefore, it takes a good way for sufferers to go through the entire process of diabetes treatment and care. Physical activity, such as brisk walking, has benefited people with diabetes and pre-diabetes. This activity has been shown to increase insulin sensitivity and reduce belly fat. Literature review aims to analyze the application of brisk walking to blood sugar levels in patients with type II diabetes mellitus over the past five years. Methods analysis of articles related to brisk walking in lowering blood sugar levels in patients with type II diabetes mellitus through data obtained from Google Scholar, EBSCO, and PubMed empirical studies in the last five years, as many as eight journals under the inclusion criteria set by the author. An analysis showed that brisk walking could reduce blood sugar levels in patients with type II diabetes mellitus. Based on the results of these eight journals, almost all journals have significant impacts that brisk walking affects blood sugar levels in patients with type II diabetes mellitus

Care processes in people in remission from type 2 diabetes: A cohort study using the National Diabetes Audit.

People with type 2 diabetes can enter remission but may relapse or develop legacy complications. This analysis assesses whether people with remission from type 2 diabetes continue receiving annual care processes recommended in national guidelines and the potential impacts of formal recognition of remission. People with type 2 diabetes with and without formal recognition (diagnostic code) of remission, and with and without evidence of remission (HbA1c < 48 mmol/mol without prescription for glucose-lowering drugs in preceding 26 weeks), included in the 2018/19 National Diabetes Audit (NDA) for England and Wales were followed up to identify care processes received between 1 January 2019 and 31 March 2020. Of the 2,822,145 people with type 2 diabetes in the cohort, 16,460 (0.58%) were coded with remission in the 2018/19 NDA. After adjustment for age, sex, socioeconomic deprivation and ethnicity, people coded with remission were less likely to receive each care process than those without such coding irrespective of HbA1c measurements (relative risk (RR) of receiving all 8 care processes 0.70 (95% CI 0.69-0.72)). For the 339,235 people with evidence of remission, irrespective of diagnostic coding compared to those without such evidence, the RR for receiving all 8 care processes was 0.94 (95% CI 0.93-0.94). People coded with remission of type 2 diabetes were less likely to receive diabetes care processes than those without such coding. People with evidence of remission had only a slightly reduced likelihood of receiving care processes. Formal recognition of remission may affect the provision or uptake of care processes.

The impact of gender patient-physician concordance on interpersonal processes of care and patients’ outcomes in the diabetes care setting

ObjectiveTo investigate whether patient-physician gender concordance influences the patient’s perceptions of interpersonal processes of care and patient outcomes in Muslim patients with diabetes. MethodsWe conducted a cross-sectional telephone survey involving 4152 randomly selected patients using electronic diabetes records. Outcome measures included perceptions of interpersonal processes of care, adherence to medications, and HbA1c. Linear mixed regression models were used to explore the associations between the outcome variables and patient gender and gender concordance. ResultsThe best processes of care were observed consistently for female concordant dyads. In adjusted mixed models, lower Hurried Communication was associated with female concordant (–0.91, p < 0.001) and female physician–male patient dyads (–0.82, p = 0.007). Higher Elicited Concerns was associated with female concordant (0.65, p = 0.003) and female physician–male patient dyads (0.59, p = 0.013). Higher Explained Results and Compassionate/Respectful were associated with female concordant dyads (0.83, p < 0.001, and 0.55, p = 0.010 respectively). Lower HbA1c was independently linked with female concordant dyads (–0.84, p < 0.001). ConclusionThis study highlights the importance of female gender concordance on perceptions of interpersonal processes of diabetes care and glycemic control. Practice ImplicationsStrengthening physicians’ communication skills with female patients should be taken into consideration.

Quality of Care for US Adults With Medicaid Insurance and Type 2 Diabetes in Federally Qualified Health Centers Compared With Other Primary Care Settings.

The objective of this study was to evaluate indicators of diabetes quality of care for US nonelderly, adult Medicaid enrollees with type 2 diabetes and compare federally qualified health centers (FQHCs) versus non-FQHCs. We analyzed diabetes process measures and acute health services utilization with 2012 US fee-for-service and managed care Medicaid claims in all 50 states and DC. We compared FQHC (N=121,977) to non-FQHC patients (N=700,401) using propensity scores to balance covariates and generalized estimating equation models. Overall, laboratory-based process measures occurred more frequently (range, 65.7%-76.6%) than measures requiring specialty referrals (retinal examinations, 33.3%; diabetes education, 3.4%). Compared with non-FQHC patients, FQHC patients had about 3 percentage point lower rates of each process measure, except for higher rates of diabetes education [relative risk=1.09, 95% confidence interval (CI): 1.03-1.16]. FQHC patients had fewer overall [incident rate ratio (IRR)=0.87, 95% CI: 0.86-0.88] and diabetes-related hospitalizations (IRR=0.79, 95% CI: 0.77-0.81), but more overall (IRR=1.06, 95% CI: 1.05-1.07) and diabetes-related emergency department visits (IRR=1.10, 95% CI: 1.08-1.13). This national analysis identified opportunities to improve diabetes management among Medicaid enrollees with type 2 diabetes, especially for retinal examinations or diabetes education. Overall, we found slightly lower rates of most diabetes care process measures for FQHC patients versus non-FQHC patients. Despite having higher rates of emergency department visits, FQHC patients were significantly less likely to be hospitalized than non-FQHC patients. These findings emphasize the need to identify innovative, effective approaches to improve diabetes care for Medicaid enrollees, especially in FQHC settings.

Can Alternative Payment Models And Value-Based Insurance Design Alter The Course Of Diabetes In The United States?

Diabetes process and outcome measures are common quality measures in payment reform models, including Alternative Payment Models (APMs) and value-based insurance design (VBID). In this commentary we review evidence from selected research to examine whether these payment models can improve the value of diabetes care. We found that higher-risk APMs yielded greater improvements in diabetes process measures than lower-risk APMs, and that VBID models appeared to improve medication adherence but not other quality measures. We argue that these models are promising first steps in redesigning the payment system to improve diabetes care. However, greater coordination and alignment across models is needed to enhance their impact on providers' behavior, diabetes care processes, and patient health outcomes.

Adherence to General Diabetes and Foot Care Processes, with Prompt Referral, Are Associated with Amputation-Free Survival in People with Type 2 Diabetes and Foot Ulcers: A Scottish National Registry Analysis.

Aims To compare different packages of care across care providers in Scotland on foot-related outcomes. Methods A retrospective cohort study with primary and secondary care electronic health records from the Scottish Diabetes Registry, including 6,845 people with type 2 diabetes and a first foot ulcer occurring between 2013 and 2017. We assessed the association between exposure to care processes and major lower extremity amputation and death. Proportional hazards were used for time-to-event univariate and multivariate analyses, adjusting for case-mix characteristics and care processes. Results were expressed in terms of hazard ratios with 95% confidence intervals. Results 2,243 (32.7%) subjects had a major amputation or death. Exposure to all nine care processes at all ages (HR = 0.63; 95% CI: 0.58-0.69; p < .001) and higher foot care attendance in people aged >70 years (HR = 0.88; 0.78-0.99; p = .03) were associated with longer major amputation-free survival. Waiting time ≥ 12 weeks between ulceration and clinic attendance was associated with worse outcomes (HR = 1.59; 1.37-1.84; p < .001). In people > 70 years, minor amputations were associated with improved major amputation-free survival (HR = 0.69; 0.52-0.92; p = .01). Conclusions Strict adherence to a standardised package of general diabetes care before foot ulceration, timely foot care after ulceration, and specific treatment pathways were associated with longer major amputation-free survival among a large cohort of people with type 2 diabetes in Scotland, with a larger impact on older age groups.

137-LB: Unmet Social Needs and Uptake of Recommended Diabetes Processes of Care in a High-Need, High-Cost Medicaid Population

Diabetes patients with unmet social needs (e.g., housing instability, food insecurity) may be less able to complete recommended processes of care than patients without these challenges. We examined survey data from a multi-state sample of Medicaid patients with diabetes (n=6,087) identified by UnitedHealthcare as high-cost, high-need based on utilization over the past year, who were enrolled in a comprehensive care coordination intervention by Optum. Before receiving any intervention services, patients reported whether they experienced housing instability, food insecurity, transportation problems, need for help with utilities, or feared for their interpersonal safety at baseline. We used data from administrative claims to measure whether these patients had 4 recommended processes of care completed within the last 18 months: 1) retinal exam, 2) ACE/ARB medication or nephropathy screening, 3) A1c testing, or 4) statin prescription ordered. We examined the cross-sectional association between unmet social needs and processes of care using multivariate logistic regression, controlling for clustering by zip code. The analytic sample was 50% White and 61% female, with 5.6 documented comorbidities on average. Overall, rates of unmet social need varied from 4% for concerns about interpersonal safety to 16% for transportation problems. Only 52% of patients had a retinal exam during the study window, 69% were prescribed a statin, 88% had their A1c checked, and 95% were taking an ACE/ARB medication or had nephropathy screening. In the regression analyses, we did not find statistically significant associations between any of the unmet social needs and the processes of care (all p values &amp;gt;0.05) . In this analysis of high-cost, high-need Medicaid patients, barriers other than unmet social needs may underpin difficulties with achieving recommended processes of care for diabetes, particularly retinal exams and statin use that are completed at lower rates. Disclosure O. Duru: None. A. M. Klomhaus: None. C. Mangione: n/a. T. Moin: None. Funding Centers for Disease Control and Prevention U18DP006128

66-OR: Diabetes Quality of Care among Medicaid Patients and Variation by Medicaid State Spending: A Natural Experiments for Translation for Diabetes 2 Study

Background: Medicaid patients have high rates of diabetes complications. We examined quality of diabetes care among Medicaid patients and variation by Medicaid state spending. Methods: Using 2015-16 United Healthcare claims (eligibility, medical, pharmacy) and lab data, we identified Medicaid patients with diabetes &amp;gt;21 yrs of age receiving care in practices with &amp;gt;1000 Medicaid patients (diabetes defined by diagnostic codes, A1c &amp;gt;6.5% or glycemic prescriptions) . Over an 18-month study period, we examined A1c testing, statin use, retinal and nephropathy screening rates. Logistic regression covariates included a categorical variable for per-beneficiary Medicaid spending terciles by state (low, middle or high) , age, gender, race, ethnicity, language, Medicaid eligibility category, indicator for type 1 vs. 2 diabetes, indicator for chronic eye diseases, comorbidity indicators, and a count of number of enrolled months. We adjusted for clustering at the 3-digit zip code level and excluded states with vision care carve-outs. Results: Among 46,5Medicaid patients with diabetes, the overall unadjusted completion rates for individual diabetes care measures varied from 39% (retinal screening) to 86% (nephropathy screening) ; 27% (7,540) of patients completed all 4 care measures. Adjusted completion rates for all 4 measures did not vary by Medicaid spending level. As compared to Whites, Asian/Pacific Islanders and patients with missing race were more likely to complete all 4 measures (5.1% and 3.7% higher respectively, p=0.00) , while Native Americans were less likely (-6.1%, p=0.04) . Medicaid patients with dual Medicare were more likely to complete all 4 measures than TANF members (4.8%, p=0.00) . Conclusions: Only 1 in 4 Medicaid patients with diabetes received all 4 diabetes care measures in our study. Interventions are needed to increase adherence to diabetes processes of care for underserved Medicaid patients with diabetes. Disclosure T.Moin: None. J.Harwood: None. O.Duru: None. C.Tseng: None. C.Mangione: n/a. Funding CDC/NIH/NIDDK U18DP006128

Associations between reductions in routine care delivery and non-COVID-19-related mortality in people with diabetes in England during the COVID-19 pandemic: a population-based parallel cohort study

BackgroundThe Office for Health Improvement and Disparities, part of the UK Government Department of Health and Social Care, highlighted an emerging signal of increased non-COVID-19-related deaths in England between July and October, 2021, with a potentially disproportionate higher increase in people with diabetes. We aimed to substantiate and quantify this apparent excess mortality, and to investigate the association between diabetes routine care delivery and non-COVID-19-related-mortality in people with diabetes before and after the onset of the pandemic.MethodsIn this population-based parallel cohort study, we used the National Diabetes Audit (NDA) to identify people with diabetes in England. The primary outcome was non-COVID-19-related deaths between July 3, 2021, and Oct 15, 2021, in participants in the 2021 COVID-19 cohort (registered in the NDA in the periods Jan 1, 2019, to March 31, 2020, and Jan 1, 2020, to March 31, 2021) compared with deaths between June 29, 2019, and Oct 11, 2019 (the equivalent 15-week period in 2019) in the 2019 pre-COVID-19 comparator cohort (people registered in the NDA in the periods Jan 1, 2017, to March 31, 2018, and Jan 1, 2018 to March 31, 2019). In each cohort, multivariable logistic regression examined whether completion of eight diabetes care processes in each of the two years before the index mortality year was associated with non-COVID-19-related death, adjusting for diabetes type, age, sex, ethnicity, and socioeconomic deprivation.FindingsThere were 3 218 570 people in the 2021 cohort and 2 973 645 people in the 2019 comparator cohort. In the 2021 cohort, there were 30 118 non-COVID-19-related deaths in people with diabetes, compared with 27 132 in the comparator cohort, representing an 11% increase (95% CI 9–13). The unadjusted incidence rate ratio (IRR) for mortality in the 2021 cohort compared to the 2019 cohort was 1·026 (1·009–1·043; p=0·003), which was unchanged after adjustment for age, sex, ethnicity, socioeconomic deprivation, and diabetes type (IRR 1·023 (1·006–1·040); p=0·007). In the 2021 cohort, 853 660 (26·5%) people received all eight care processes in 2020–21 compared with 1 547 240 (48·1%) people in 2019–20; a 44·8% (95% CI 44·7–45·0) relative reduction. In the pre-COVID-19 comparator cohort, 1 370 315 (46·1%) people with diabetes received all eight care processes in 2018–19 compared with 1 437 740 (48·3%) in 2017–18; a 4·7% (95% CI 4·5–4·9) relative decrease. Non-COVID-19-related mortality in the 2021 cohort was highest in people who did not receive all eight care processes in either of the two previous years (OR 2·67 [95% CI 2·56–2·77]; p<0·001) compared with those who received all eight care processes in both previous years. Mortality was also significantly higher in those who received all eight care processes in 2019–20 but not in 2020–21 (OR 1·66 [95% CI 1·59–1·73]; p<0·001) or not in 2019–20 but in 2020–21 (OR 1·27 [1·20–1·35]; p<0·001). This pattern of association was similar in the 2019 pre-COVID-19 cohort.InterpretationOur results show an increased risk of mortality in those who did not receive all eight care processes in one or both of the previous two years. Our results provide evidence that the increased rate of non-COVID-19-related mortality in people with diabetes in England observed between July 3, and Oct 15 of 2021 is associated with a reduction in completion of routine diabetes care processes following the pandemic onset in 2020.FundingNone.

The effect of COVID-19 on routine diabetes care and mortality in people with diabetes

The effect of COVID-19 on routine diabetes care and mortality in people with diabetes

Impact of the COVID-19 Pandemic on Diabetes Care Among a North Carolina Patient Population.

In this study, researchers reviewed electronic health record data to assess whether the coronavirus disease 2019 pandemic was associated with disruptions in diabetes care processes of A1C testing, retinal screening, and nephropathy evaluation among patients receiving care with Wake Forest Baptist Health in North Carolina. Compared with the pre-pandemic period, they found an increase of 13-21 percentage points in the proportion of patients delaying diabetes care for each measure during the pandemic. Alarmingly, delays in A1C testing were greatest for individuals with the most severe disease and may portend an increase in diabetes complications.

Disparity in diabetic eye complications among racial/ethnic minorities: an analysis of the 2009–2018 United States Medical Expenditure Panel Survey

AimsTo evaluate the prevalence and risk factors of diabetic eye complications among the United States (US) adults and examine the differences across racial and ethnic groups. MethodsUsing the 2009–2018 Medical Expenditures Panel Survey (MEPS) data, this study included adults with diabetes conditions. Patients were grouped into African Americans, Hispanics, and Whites based on self-reported identity. The rate of diabetic eye complications was reported and compared across racial/ethnic groups. This study applied multivariable logistic regression models to examine dilated eye exam attendance, and the completion of American Diabetes Association (ADA) recommended guidelines for diabetes care across racial/ethnic groups. ResultsThis study identified 8,080 patients with diabetic eye complications, which represented a national estimation of 4.12 million US adults according to MEPS data. Among diabetic patients, Hispanics (18.78%) and African Americans (18.18%) had higher rates of eye complications than Whites (12.71%). After adjusting relevant demographic, socioeconomic, and clinical variables, the multivariable model found that Hispanics and African Americans had 1.63 and 1.61 times more likely to have diabetic eye complications compared to Whites. In addition, African Americans were 29% less likely to complete all of the ADA-recommended processes of diabetes care than White patients. ConclusionsCompared to White patients, Hispanics and African Americans were more likely to have diabetic eye complications and were less likely to manage diabetes appropriately. Healthcare providers and policymakers should promote interventions and education programs accordingly to prevent and reduce the development of eye complications among minorities.

Abstract MP11: Impact Of Severe Acute Respiratory Syndrome Coronavirus 2 (sars-cov-2) Pandemic On Diabetes Care Among A North Carolina Patient Population

Introduction: We assessed whether the coronavirus disease 2019 (COVID-19) pandemic was associated with within-individual delays in diabetes care processes of glycated hemoglobin (HbA1c) testing, retinal exam, and nephropathy evaluation among patients receiving regular care with Wake Forest Baptist Health (WFBH), overall and stratified by clinical factors, race and ethnicity, and socioeconomic status. Methods: We used electronic health record data for 25,323 WFBH adult patients with diabetes (96% type 2; 53% women; mean age ± SD: 63±13 years). We used Current Procedural Terminology codes to identify each diabetes care process occurring between 3/1/2018 and 2/28/2021. Delayed care between serial assessments was defined as a duration of &gt;6 months for HbA1c testing and &gt;12 months for retinal exam and nephropathy evaluation. We used individual-level fixed effects regression to estimate within-person change in outcomes before and after the start of the COVID-19 pandemic (3/1/2020), overall and among subgroups. Results: During the pandemic, there was a 12.7 to 20.6 percentage point increase in the incidence of delayed diabetes care ( Table ). We did not observe clinically meaningful differences in delayed care for any of the diabetes care procedures during the pandemic across socio-demographic subgroups. However, individuals with the highest HbA1c and greatest burden of comorbidities, respectively, had the greatest increase in the incidence of a delayed HbA1c test during the pandemic. Conclusions: The COVID-19 pandemic was associated with an increase in within-individual delays in HbA1c testing, retinal exams, and nephropathy evaluations. Delays were greatest for individuals with the most severe disease and may portend an increase in diabetes complications.

Variation in appropriate diabetes care and treatment targets in urban and rural areas in England: an observational study of the ‘rule of halves’

ObjectivesTo estimate the ‘rule of halves’ for diabetes care for urban and rural areas in England using several data sources covering the period 2015–2017; and to examine the extent to...

Relationship between housing insecurity, diabetes processes of care, and self-care behaviors

BackgroundThe aim of this analysis was to examine the influence of housing insecurity on diabetes processes of care and self-care behaviors and determine if that relationship varied by employment status or race/ethnicity.MethodsUsing nationally representative data from the Behavioral Risk Factor Surveillance System (2014-2015), 16,091 individuals were analyzed for the cross-sectional study. Housing insecurity was defined as how often respondents reported being worried or stressed about having enough money to pay rent/mortgage. Following unadjusted logistic models testing interactions between housing insecurity and either employment or race/ethnicity on diabetes processes of care and self-care behaviors, stratified models were adjusted for demographics, socioeconomic status, health insurance status, and comorbidity count.Results38.1% of adults with diabetes reported housing insecurity. Those reporting housing insecurity who were employed were less likely to have a physicians visit (0.58, 95%CI 0.37,0.92), A1c check (0.45, 95%CI 0.26,0.78), and eye exam (0.61, 95%CI 0.44,0.83), while unemployed individuals were less likely to have a flu vaccine (0.84, 95%CI 0.70,0.99). Housing insecure White adults were less likely to receive an eye exam (0.67, 95%CI 0.54,0.83), flu vaccine (0.84, 95%CI 0.71,0.99) or engage in physical activity (0.82, 95%CI 0.69,0.96), while housing insecure Non-Hispanic Black adults were less likely to have a physicians visit (0.56, 95%CI 0.32,0.99).ConclusionsHousing insecurity had an influence on diabetes processes of care and self-care behaviors, and this relationship varied by employment status and race/ethnicity. Diabetes interventions should incorporate discussion surrounding housing insecurity and consider differences in the impact by demographic factors on diabetes care.