Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study.

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  • Additional Information
    • Publication Year:
      2019
    • Author-Supplied Keywords:
      Biochemistry
      Biology and life sciences
      Cholesterol
      Diabetes diagnosis and management
      Diabetes mellitus
      Diabetic endocrinology
      Diagnostic medicine
      Endocrine disorders
      Endocrinology
      Ethnicities
      HbA1c
      Health care
      Hemoglobin
      Hispanic people
      Hormones
      Insulin
      Lipids
      Medicine and health sciences
      Metabolic disorders
      People and places
      Population groupings
      Primary care
      Proteins
      Research Article
      Type 2 diabetes
    • Subject Terms:
    • NAICS/Industry Codes:
      NAICS/Industry Codes 923120 Administration of Public Health Programs
      923140 Administration of Veterans' Affairs
    • Abstract:
      Objective: Patients with persistent poorly-controlled diabetes mellitus (PPDM) despite engagement in clinic-based care are at particularly high risk for diabetes complications and costs. Understanding this population’s demographics, comorbidities and care utilization could guide strategies to address PPDM. We characterized factors associated with PPDM in a large sample of Veterans with type 2 diabetes. Methods: We identified a cohort of Veterans with medically treated type 2 diabetes, who received Veterans Health Administration primary care during fiscal years 2012 and 2013. PPDM was defined by hemoglobin A1c levels uniformly >8.5% during fiscal year (FY) 2012, despite engagement with care during this period. We used FY 2012 demographic, comorbidity and medication data to describe PPDM in relation to better-controlled diabetes patients and created multivariable models to examine associations between clinical factors and PPDM. We also constructed multivariable models to explore the association between PPDM and FY 2013 care utilization. Results: In our cohort of diabetes patients (n = 435,820), 12% met criteria for PPDM. Patients with PPDM were younger than better-controlled patients, less often married, and more often Black/African-American and Hispanic or Latino/Latina. Of included comorbidities, only retinopathy (OR 1.68, 95% confidence interval (CI): 1.63,1.73) and nephropathy (OR 1.26, 95% CI: 1.19,1.34) demonstrated clinically significant associations with PPDM. Complex insulin regimens such as premixed (OR 10.80, 95% CI: 10.11,11.54) and prandial-containing regimens (OR 18.74, 95% CI: 17.73,19.81) were strongly associated with PPDM. Patients with PPDM had higher care utilization, particularly endocrinology care (RR 3.56, 95% CI: 3.47,3.66); although only 26.4% of patients saw endocrinology overall. Conclusion: PPDM is strongly associated with complex diabetes regimens, although heterogeneity in care utilization exists. While there is evidence of underutilization, inadequacy of available care may also contribute to PPDM. Our findings should inform tailored approaches to meet the needs of PPDM, who are among the highest-risk, highest-cost patients with diabetes. [ABSTRACT FROM AUTHOR]
    • Abstract:
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    • ISSN:
      19326203
    • Accession Number:
      135636949
  • Citations
    • ABNT:
      ALEXOPOULOS, A.-S. et al. Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study. PLoS ONE, [s. l.], v. 14, n. 3, p. 1, 2019. Disponível em: . Acesso em: 24 ago. 2019.
    • AMA:
      Alexopoulos A-S, Jackson GL, Edelman D, et al. Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study. PLoS ONE. 2019;14(3):1. http://ezproxy.parker.edu/login?url={targeturl}. Accessed August 24, 2019.
    • APA:
      Alexopoulos, A.-S., Jackson, G. L., Edelman, D., Smith, V. A., Berkowitz, T. S. Z., Woolson, S. L., … Crowley, M. J. (2019). Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study. PLoS ONE, 14(3), 1. Retrieved from http://ezproxy.parker.edu/login?url={targeturl}
    • Chicago/Turabian: Author-Date:
      Alexopoulos, Anastasia-Stefania, George L. Jackson, David Edelman, Valerie A. Smith, Theodore S. Z. Berkowitz, Sandra L. Woolson, Hayden B. Bosworth, and Matthew J. Crowley. 2019. “Clinical Factors Associated with Persistently Poor Diabetes Control in the Veterans Health Administration: A Nationwide Cohort Study.” PLoS ONE 14 (3): 1. http://ezproxy.parker.edu/login?url={targeturl}.
    • Harvard:
      Alexopoulos, A.-S. et al. (2019) ‘Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study’, PLoS ONE, 14(3), p. 1. Available at: http://ezproxy.parker.edu/login?url={targeturl} (Accessed: 24 August 2019).
    • Harvard: Australian:
      Alexopoulos, A-S, Jackson, GL, Edelman, D, Smith, VA, Berkowitz, TSZ, Woolson, SL, Bosworth, HB & Crowley, MJ 2019, ‘Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study’, PLoS ONE, vol. 14, no. 3, p. 1, viewed 24 August 2019, .
    • MLA:
      Alexopoulos, Anastasia-Stefania, et al. “Clinical Factors Associated with Persistently Poor Diabetes Control in the Veterans Health Administration: A Nationwide Cohort Study.” PLoS ONE, vol. 14, no. 3, Mar. 2019, p. 1. EBSCOhost, ezproxy.parker.edu/login?url={targeturl}.
    • Chicago/Turabian: Humanities:
      Alexopoulos, Anastasia-Stefania, George L. Jackson, David Edelman, Valerie A. Smith, Theodore S. Z. Berkowitz, Sandra L. Woolson, Hayden B. Bosworth, and Matthew J. Crowley. “Clinical Factors Associated with Persistently Poor Diabetes Control in the Veterans Health Administration: A Nationwide Cohort Study.” PLoS ONE 14, no. 3 (March 29, 2019): 1. http://ezproxy.parker.edu/login?url={targeturl}.
    • Vancouver/ICMJE:
      Alexopoulos A-S, Jackson GL, Edelman D, Smith VA, Berkowitz TSZ, Woolson SL, et al. Clinical factors associated with persistently poor diabetes control in the Veterans Health Administration: A nationwide cohort study. PLoS ONE [Internet]. 2019 Mar 29 [cited 2019 Aug 24];14(3):1. Available from: http://ezproxy.parker.edu/login?url={targeturl}