Revisit frequency and its association with quality of care among diabetic patients: Translating Research Into Action for Diabetes (TRIAD)

Persistence with once-weekly glucagon-like peptide 1 receptor agonist therapy decreases the risk of major adverse cardiovascular events: A retrospective analysis of patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease

AIMS

To assess the association between remaining persistent with once-weekly glucagon-like peptide-1 receptor agonists (OW GLP-1 RAs) and the risk of major adverse cardiovascular events (MACE) among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD).

METHODS

We used the Optum Research Database to identify patients who initiated OW GLP-1 RAs between 1/1/2018-11/30/2022. Patients were classified as persistent or non-persistent depending on whether there was a ≥ 60-day gap in medication supply after they continuously used the medication for the first three months. Adjusted time-varying Cox proportional hazards models assessed the associations between persistence status and risks of 2-point MACE, stroke, and myocardial infarction (MI).

RESULTS

Persistent (n = 18,849) and non-persistent (n = 10,667) patients were followed for an average of 418 and 741 days, respectively. Mean (SD) persistence was 418 (339), and 288 (234) days for persistent and non-persistent patients, respectively. Remaining persistent was associated with significantly lower risks of 2-point MACE, stroke, and MI (all p < 0.001). The corresponding HRs (95 %CI) were 0.696 (0.626-0.774), 0.668 (0.573-0.777), and 0.710 (0.621-0.813).

CONCLUSIONS

Persistence with OW GLP-1 RA therapy was associated with significantly lower MACE risk among patients with T2DM and ASCVD in a real-world setting.

Impact of general practitioner appointment frequency on disease management in type 2 diabetes mellitus patients

AIMS

We investigated the association between the frequency of visits to general practitioners (GPs) and the degree of disease control in patients with T2DM.

METHODS

This study included patients diagnosed with T2DM who visited their GPs between 2014 and 2018. A total of 89,674 patients, accounting for 1,203,035 visits, were included. Different clinical features such as glycated hemoglobin (HbA1c%), blood pressure (BP), and c-LDL levels were analyzed. Multifactorial control of T2DM was defined as HbA1c ≤ 7 %, BP ≤ 140/90 mmHg, and LDL cholesterol ≤ 100 mg/dL. Generalized Estimating Equations models were implemented in order to deal with repeated measures for the same patient.

RESULTS

The median age of the patients is 70 years, with 52.8 % being male. An increase in the number of visits per year significantly improves the likelihood of achieving multifactorial diabetes control. Patients with more than 3-visits per year (55.6 %) have a Relative Risks (RR) of 1.258 (95 % Confidence Interval: 1.120-1.414). Frequent visits are associated with better multifactorial control and better c-LDL management. Patients visiting more than 3-times annually tend to achieve better outcomes in multifactorial and c-LDL control.

CONCLUSION

Increasing the frequency of primary care visits significantly enhances multifactorial and cholesterol control among T2DM patients.

Optimizing the frequency of physician encounters in follow - up care for patients with type 2 diabetes mellitus: a systematic review

BACKGROUND

Decisions on the frequency of physician encounters for patients with type 2 diabetes mellitus (T2DM) have significant impacts on both patients' health outcomes and burden on health systems, whereas definitive intervals for physician encounters are still lacking in most clinical guidelines. This study systematically reviewed the existing evidence evaluating different frequencies of physician encounters among T2DM patients.

METHODS

Systematic search of studies evaluating different visit frequencies for follow - up care in T2DM patients was performed in MEDLINE Ovid, Embase Ovid, and Cochrane library from database inception to 25 March 2022. Studies on the follow - up encounters driven by non - physicians and those on the episodic visits in the acute care settings were excluded in the screening. Citation searching was conducted via Google Scholar on the identified papers after screening. The risk of bias was assessed using Cochrane RoB2 tool for randomized controlled trials and Newcastle - Ottawa Scale for cohort studies. Findings were summarized narratively.

RESULTS

Among 6363 records from the database search and 231 references from the citation search, 12 articles were eligible for in - depth review. The results showed that for patients who had not achieved cardiometabolic control, intensifying encounter frequency could enhance medication adherence, shorten the time to achieve the treatment target, and improve the patients' quality of life. However, for the patients who had already achieved the treatment targets, less frequent encounters were equivalent to intensive encounters in maintaining their cardiometabolic control, and could save considerable healthcare costs without substantially lowering the quality of care and patients' satisfaction.

CONCLUSION

Existing evidence suggested that the optimal frequency of physician encounters for patients with T2DM should be individualized, which can be stratified by patients' risk levels based on the cardiometabolic control to guide the differential scheduling of physician encounters in the follow - up. More research is needed to determine how to optimize the frequency of physician encounters for this large and heterogeneous population.

Poor glycemic control and associated factors among patients with type 2 diabetes mellitus: a cross-sectional study

Glycemic control is of paramount importance in care and management for patients with type 2 diabetes mellitus (T2DM). Poor glycemic control is a major health problem that greatly contributes to the development of diabetes related complications. This study aims to assess the prevalence of poor glycemic control and associated factors among outpatients with T2DM attending diabetes clinic at Amana Regional Referral Hospital in Dar-es-salaam, Tanzania from December 2021 to September 2022. A face to face interviewer semi-structured questionnaire was administered during data collection. Binary logistic regression under multivariable analysis was used to determine the independent predictors of poor glycemic control. A total of 248 patients with T2DM were included in the analysis with mean age of 59.8 ± 12.1 years. The mean fasting blood glucose was 166.9 ± 60.8 mg/dL. The prevalence of poor glycemic control was 66.1% (fasting blood glucose > 130 mg/dL or < 70 mg/dL). Failure to adhere to regular follow-up (AOR = 7.53, 95% CI = 2.34-19.73, p < 0.001) and alcoholism (AOR = 4.71, 95% CI = 1.08-20.59, p = 0.040) were the independent predictors of poor glycemic control. The prevalence of poor glycemic control observed in this study was significantly high. Emphasis should be placed on ensuring that patients have regular follow-up for their diabetes clinics and they should also continue modifying some of lifestyle behaviors including refraining from alcoholism, this can help them to have good glycemic control.

Follow-up frequency and clinical outcomes in patients with type 2 diabetes: A prospective analysis based on multicenter real-world data

BACKGROUND

To determine whether the follow-up frequency for type 2 diabetes mellitus (T2DM) patients in the National Metabolic Management Centers (MMCs) leads to different clinical outcomes.

METHODS

A total of 19 908 T2DM patients with at least 6 months of facility-based follow-up were recruited in MMCs between June 2017 and April 2021 and divided into lower-frequency and higher-frequency follow-up (LFF and HFF) groups according to the median follow-up frequency of 2.0 (interquartile range 1.2) times per year. Metabolic parameters at baseline and at the last follow-up visit were analyzed. Multivariable linear regression models were performed to assess the relationship between follow-up frequency and between-group percentage changes, adjusting for the major covariables. Additional stratified analyses were conducted to evaluate the metabolic outcomes in the subgroups.

RESULTS

The characteristics of the participants in the LFF and HFF groups were significantly different at baseline. Participants had significant improvements in multiple metabolic parameters after follow-up. Patients with HFF showed significantly greater decrease in percentage changes of fasting blood glucose (-4.95% ± 37.96% vs -2.21% ± 43.08%, P < .0001) and glycosylated hemoglobin (HbA1c) (-12.14% ± 19.78% vs -9.67% ± 20.29%, P < .0001) after adjustments compared to those with LFF. Furthermore, stratification analyses showed that significant between-group percentage changes of HbA1c were observed in those with younger age (<55 years) and higher HbA1c (>9%) at baseline (P for interaction <.001).

CONCLUSIONS

HFF is associated with better metabolic outcomes. Participants, especially with younger age or worse HbA1c at baseline in the HFF group achieved better glycemic control than those in the LFF group.

Spatial Healthcare Accessibility: A District-Level Analysis of Travel for Outpatient Diabetology in Czechia

Assessments of regional differences in the accessibility and capacity of health services often rely on indicators based on data from the permanent residents of a given region. However, a patient does not always use health services in their place of residence. The objective of this article is to evaluate the influence of spatial healthcare accessibility on regional differences in the provision and take-up of health services, using outpatient diabetology in Czechia as a case study. The analysis is grounded in monitoring the differences in the patient's place of residence and the location of the healthcare provided. Anonymized individual data of the largest Czech health insurance company for 2019 are used (366,537 patients, 2,481,129 medical procedures). The data are aggregated at the district level (LAU 1). It has been identified that regions where patients travel outside their area of residence to access more than half of their healthcare needs are mostly in local/regional centres. Moreover, these patients increase the number of medical services provided in local/regional centres, often by more than 20%, which has been reflected in greater healthcare capacity in these centres. To assess regional differences, it is important to take the spatial healthcare accessibility into account and also consider why patients travel for healthcare. Reasons could be the insufficient local capacity, varied quality of health services or individual factors. In such cases, healthcare actors (health insurance companies, local government etc.) should respond to the situation and take appropriate action to reduce these dissimilarities.

Primary Care Provider Encounter Cadence and HbA1c Control in Older Patients With Diabetes

INTRODUCTION

Primary care provider encounters are associated with health and well-being; however, limited evidence guides optimal primary care provider rate of visit, referred to as encounter cadence. This study measures associations between primary care provider encounter cadence and diabetes outcomes among individuals newly diagnosed with type 2 diabetes mellitus.

METHODS

In this retrospective cohort study, 7,106 people enrolled in Medicare Advantage and newly diagnosed with type 2 diabetes mellitus between July 1, 2012 and June 30, 2013 were identified and followed for 36 months. Two methods measured primary care provider encounter cadence: total primary care provider encounters (frequency) and quarters with primary care provider encounter (regularity). Logistic regression measured relationships between primary care provider encounter cadence and non-insulin diabetes medication adherence, HbA1c control, emergency department visits, and inpatient admissions. Non-insulin diabetes medication adherence was defined according to the National Committee for Quality Assurance, Healthcare Effectiveness Data and Information Set specifications and measured using healthcare claims data. Post-hoc models examined adherence and diabetes control among those nonadherent (n=5,212) and with noncontrolled HbA1c (n=326) during the encounter/cadence period. Data were extracted and analyzed in 2017.

RESULTS

Adjusted models indicated that both frequency (AOR=1.08, 95% CI=1.06, 1.10) and regularity (AOR=1.18, 95% CI=1.13, 1.22) of primary care provider encounters were associated with increased odds of adherence. Post-hoc analyses indicated that more frequent (AOR=1.12, 95% CI=1.10, 1.15) and regular (AOR=1.27, 95% CI=1.22, 1.33) primary care provider encounters were associated significantly with adherence and were associated directionally with HbA1c control.

CONCLUSIONS

More frequent and regular primary care provider encounters are associated with an increased likelihood of non-insulin diabetes medication adherence. These findings contribute to data needed to establish evidence-based guidelines for primary care provider encounter cadence for those newly diagnosed with type 2 diabetes mellitus.

Effectiveness of monthly and bimonthly follow-up of patients with well-controlled type 2 diabetes: a propensity score matched cohort study

BACKGROUND

On average, patients in Japan with type 2 diabetes mellitus have a clinical consultation every month, although evidence for a favorable follow-up interval is lacking. This study investigated whether the follow-up interval can be extended by comparing the clinical outcomes and cost for monthly versus bimonthly follow-up of patients with well-controlled diabetes mellitus.

METHODS

We combined administrative claims data from the National Health Insurance and the Health Checkups Program data of Tsu city, Japan between 2011 and 2014 to conduct a retrospective cohort study of patients with well-controlled type 2 diabetes mellitus. Propensity scores were used to assemble a matched-pairs cohort from patients who had monthly and bimonthly follow-up. Equivalence between two groups was assessed by designating the proportion of patients who maintained good control of their diabetes in the subsequent year as a primary outcome. The proportion achieving target blood pressure and lipid levels, favorable lifestyle, and annual cost were compared as secondary outcomes.

RESULTS

Of 12,145 participants, 693 with monthly follow-up and 693 with bimonthly follow-up were matched using propensity scores. In the monthly follow-up group 654 (94.4%) remained under good diabetic control, versus 658 (95.0%) in the bimonthly group (difference: 0.6%; 95% confidence interval: - 1.8 to 2.9%). All secondary outcomes were equivalent for the monthly and bimonthly follow-up groups except the proportion achieving target blood pressure, the proportion engaging in regular exercise, and annual cost.

CONCLUSIONS

For patients with well-controlled diabetes mellitus, although frequent follow-up by a physician does not affect the control of blood glucose level in the subsequent year, the annual treatment cost becomes much higher. We suggest that patients with well-controlled diabetes can be followed up less often.

Correlates of health care use among White and minority men and women with diabetes: An NHANES study

AIMS

The current study sought to identify patient-level factors related to health care use among White and minority men and women with diabetes.

METHODS

A sample of 447 of non-pregnant individuals with diabetes, ages 18-64, was drawn from the 2015-2016 National Health and Nutrition Examination Surveys dataset. Poisson regression models tested associations between health care use and self-rated health, depression, medical comorbidities, body mass index, marital status, number of children, income, insurance coverage, and age, stratified by gender and racial/ethnic minority status.

RESULTS

Poorer self-rated health was the only significant correlate of increased health care use among White men with diabetes whereas income and insurance were significant correlates of increased use among minority men. Among White and minority women, higher levels of depression and being single were correlated with greater health care use. Comorbid medical conditions and insurance coverage were also related to use among minority women.

CONCLUSIONS

Among individuals with diabetes, health care use among White men appeared to be driven by subjective health whereas financial factors were critical among minority men. Family structure and mental health were instrumentally associated with health care use among all women. These factors can be targeted to promote equitable access to care.

Association between encounter frequency and time to blood pressure control among patients with newly diagnosed hypertension: a retrospective cohort study

This retrospective cohort study of 95 957 patients from a large integrated healthcare organization was conducted to examine whether the frequency and intervals between outpatient encounters were associated with achieving blood pressure (BP) control. Patients were followed up until they were censored or achieved BP control up to 1 year. Additionally, this study examined the time to BP control. On average, follow-up was significantly longer in patients with uncontrolled BP at 292.9 days compared with 232.2 days in those with BP control. The controlled BP group had significantly more encounters on average compared with the uncontrolled BP group (4.1 vs 3.1, standardized difference 0.33). As the number of days increased between encounters from the 1 to < 14 days, there was a consistently lower likelihood of achieving BP control. Encounter intervals of ≥180 days were associated with the lowest likelihood of achieving BP control. These findings suggest that there may be an optimal number of encounters to benefit patients with hypertension.