Patient, physician, and health system factors associated with five types of inadequate care during management of type-2 diabetes mellitus in the United States

Abstract

Aims: Non-adherence to evidence-based guidelines is major issue when managing type 2 diabetes mellitus (T2DM) that can result in increased risk of diabetes-related complications. This study aims to examine the predictors of inadequate T2DM care, incorporating patient, physician, and health system factors. Methods: A retrospective longitudinal analysis using year 2016–2018 Medical Expenditure Panel Survey data was conducted. Inadequate Care was defined using American Diabetes Association (ADA) Standards of Diabetes guidelines, resulting in five categories: immunization, pharmacologic therapy, lifestyle management, laboratory evaluation, and physical examination. A logistic regression model was used to estimate effects of patient, physician, and health systems factors on inadequate care. Results: The study cohort consisted of 1,491 individuals, representing 14,379,304 individuals. Prevalence of inadequate care was estimated at 27%, 44%, 24%, 31%, and 25% of inadequate care for metrics immunization, pharmacologic therapy, lifestyle management, laboratory evaluation, and physical examination, respectively. Fourteen out of 19 of the predictors measured were associated with at least one category of inadequate care. Conclusions: Inadequate T2DM care is an extensive issue, with a variety of associated factors, including patient, physician, and health system factors. Some characteristics, including diabetes complications severity index, insurance type, poverty level, and usual diabetes care facility were associated with over a 100% increase in inadequate care received. The study findings may inform the development of intervention programs to improve adherence to ADA guidelines on T2D management.

Keywords

• Type 2 diabetes mellitus
• Quality of diabetes care
• Evidence based guidelines
• Healthcare System
• Adherence to guidelines