INTRODUCTION
METHODS
Data
Study Population
Measures
Dependent Variable: Glycemic Control
Key Independent Variables—Chronic Illness with Complexity
Other Independent Variables
Statistical Techniques
FINDINGS
N
| Percent | |
---|---|---|
All | 95,423 | 100.0 |
Nondiabetes physical illness complexity | ||
Any cancer | 12,457 | 13.1 |
Gastrointestinal only (GI) | 2,878 | 3.0 |
Pulmonary only (PU) | 6,260 | 6.6 |
Musculoskeletal only (MS) | 21,979 | 23.0 |
Any two (GI, PU, MS) | 8,066 | 8.5 |
All three (GI, PU, MS) | 795 | 0.8 |
No cancer, GI, PU, MS | 42,988 | 45.1 |
Diabetes-related complexity | ||
Macrovascular complications | ||
Yes | 42,376 | 44.4 |
No | 53,047 | 55.6 |
Microvascular complications | ||
Yes | 33,012 | 34.6 |
No | 62,411 | 65.4 |
Metabolic decompensation | ||
Yes | 29,735 | 31.2 |
No | 65,688 | 68.8 |
Mental illness and substance abuse complexity | ||
None | 64,208 | 67.3 |
Only substance abuse | 6,956 | 7.3 |
Only mental illness | 18,431 | 19.3 |
Both | 5,828 | 6.1 |
Medication use § | ||
No oral hypoglycemics | 18,403 | 19.3 |
Oral hypoglycemics only | 49,215 | 51.6 |
Insulin only | 17,207 | 18.0 |
Oral hypoglycemics and insulin | 10,598 | 11.1 |
Gender | ||
Women | 2,024 | 2.1 |
Men | 93,399 | 97.9 |
Race/Ethnicity | ||
White | 65,296 | 68.4 |
African American | 16,437 | 17.2 |
Latino | 3,513 | 3.7 |
Other | 10,177 | 10.7 |
Age | ||
<55 years | 30,039 | 31.5 |
55–64 years | 26,410 | 27.7 |
65–75 years | 38,974 | 40.8 |
Marital status | ||
Married | 58,635 | 61.4 |
Other | 36,788 | 38.6 |
Priority status FY1999 | ||
SC disability >30% | 18,443 | 19.3 |
SC disability <20% | 19,676 | 20.6 |
Non-SC, low income | 49,634 | 52.0 |
Non-SC, high income | 7,670 | 8.0 |
Medicare enrollment FY1999 | ||
Yes | 57,167 | 59.9 |
No | 38,256 | 40.1 |
Medicare enrollment FY 2000 | ||
Yes | 57,532 | 60.3 |
No | 37,891 | 39.7 |
Dual VHA/Medicare use § | ||
VHA/Medicare | 8,659 | 9.1 |
Single | 48,508 | 50.8 |
No Medicare enrollment | 38,256 | 40.1 |
Endocrinology visit § | ||
Yes | 3,129 | 3.3 |
No | 92,294 | 96.7 |
HbA1c values 1999 | ||
Less than 7% | 31,267 | 32.8 |
7–<8% | 24,369 | 25.5 |
≥8% | 39,787 | 41.7 |
HbA1c values 2000 | ||
Less than 7% | 35,472 | 37.2 |
7–<8% | 23,819 | 25.0 |
≥8% | 36,132 | 37.9 |
Chronic Illness with Complexity
Nondiabetes Physical Illness Complexity
Diabetes-Related Complexity
Mental Illness/Substance Abuse Complexity
Baseline Glycemic Control and Chronic Illness with Complexity
With optimal glycemic control | Logistic regression on optimal glycemic control | |||
---|---|---|---|---|
N
| % | AOR | 95% CI | |
All | 31,267 | 32.8 | ||
Nondiabetes physical illness complexity*** | ||||
Any cancer | 4,643 | 37.3 | 1.31 | [1.25, 1.37]*** |
Gastrointestinal only (GI) | 1,095 | 38.0 | 1.56 | [1.43, 1.69]*** |
Pulmonary only (PU) | 2,031 | 32.4 | 1.12 | [1.05, 1.19]*** |
Musculoskeletal only (MS) | 7,612 | 34.6 | 1.22 | [1.17, 1.26]*** |
Any two (GI, PU, MS) | 2,972 | 36.8 | 1.37 | [1.30, 1.44]*** |
All three (GI, PU, MS) | 306 | 38.5 | 1.44 | [1.24, 1.67]*** |
No cancer, GI, PU, MS | 12,608 | 29.3 | ||
Diabetes-related complexity | ||||
Macrovascular complications*** | ||||
Yes | 13,604 | 32.1 | 0.91 | [0.89, 0.94]*** |
No | 17,663 | 33.3 | ||
Microvascular complications*** | ||||
Yes | 9,278 | 28.1 | 0.85 | [0.82, 0.87]*** |
No | 21,989 | 35.2 | ||
Metabolic decompensation*** | ||||
Yes | 7,764 | 26.1 | 0.70 | [0.68, 0.72]*** |
No | 23,503 | 35.8 | ||
Mental illness and substance abuse complexity*** | ||||
None | 20,585 | 32.1 | ||
Only substance abuse | 2,262 | 32.5 | 1.05 | [0.99, 1.11] |
Only mental illness | 6,461 | 35.1 | 1.18 | [1.14, 1.22]*** |
Both | 1,959 | 33.6 | 1.15 | [1.08, 1.22]*** |
Medication use §*** | ||||
No oral hypoglycemics | 9,164 | 49.8 | 1.85 | [1.78, 1.91]*** |
Oral hypoglycemics only | 16,799 | 34.1 | ||
Insulin Only | 3,539 | 20.6 | 0.53 | [0.51, 0.55]*** |
Oral hypoglycemics and insulin | 1,765 | 16.7 | 0.41 | [0.39, 0.44]*** |
Gender | ||||
Women | 649 | 32.1 | 1.06 | [0.96, 1.17] |
Men | 30,618 | 32.8 | ||
Race/Ethnicity*** | ||||
White | 22,392 | 34.3 | ||
African American | 4,852 | 29.5 | 0.89 | [0.85, 0.92]*** |
Latino | 1,078 | 30.7 | 0.92 | [0.85, 1.00]* |
Other | 2,945 | 28.9 | 0.89 | [0.85, 0.94]*** |
Age*** | ||||
<55 years | 8,577 | 28.6 | ||
55–64 years | 8,463 | 32.0 | 1.18 | [1.14, 1.23]*** |
65–75 years | 14,227 | 36.5 | 1.32 | [1.26, 1.39]*** |
Marital status** | ||||
Married | 19,434 | 33.1 | 0.99 | [0.96, 1.02] |
Other | 11,833 | 32.2 | ||
Priority status FY1999*** | ||||
SC disability > 30% | 6,253 | 33.9 | 1.06 | [0.99, 1.12] |
SC disability < 20% | 6,405 | 32.6 | 0.98 | [0.92, 1.04] |
Non-SC, low income | 16,030 | 32.3 | ||
Non-SC, high income | 2,579 | 33.6 | 0.96 | [0.91, 1.01] |
Dual VHA/Medicare use §*** | ||||
VHA/Medicare | 2,908 | 33.6 | 1.01 | [0.96, 1.06] |
Single | 17,151 | 35.4 | ||
No Medicare enrollment | 11,208 | 29.3 | 0.90 | [0.86, 0.94]*** |
Endocrinology visit §*** | ||||
Yes | 887 | 28.3 | 1.03 | [0.95, 1.12] |
No | 30,380 | 32.9 |
Longitudinal Optimal Glycemic Control and Chronic Illness with Complexity
With optimal glycemic control | Logistic regression on optimal glycemic control | |||||
---|---|---|---|---|---|---|
N
| % | Sig | AOR | 95% CI | Sig | |
All | 13,056 | 20.4 | ||||
Nondiabetes physical illness complexity | *** | |||||
Any cancer | 1,884 | 24.1 | 1.24 | [1.17, 1.32] | *** | |
Gastrointestinal only (GI) | 411 | 23.1 | 1.31 | [1.17, 1.47] | *** | |
Pulmonary only (PU) | 875 | 20.7 | 1.08 | [0.99, 1.17] | ||
Musculoskeletal only (MS) | 3,080 | 21.4 | 1.17 | [1.12, 1.23] | *** | |
Any two (GI, PU, MS) | 1,163 | 22.8 | 1.20 | [1.12, 1.30] | *** | |
All three (GI, PU, MS) | 127 | 26.0 | 1.34 | [1.09, 1.65] | ** | |
No cancer, GI, PU, MS | 5,516 | 18.2 | ||||
Diabetes-related complexity | ||||||
Macrovascular complications | ||||||
Yes | 5,954 | 20.7 | 0.90 | [0.86, 0.94] | *** | |
No | 7,102 | 20.1 | ||||
Microvascular complications | *** | |||||
Yes | 4,394 | 18.5 | 0.88 | [0.84, 0.92] | *** | |
No | 8,662 | 21.4 | ||||
Metabolic decompensation | *** | |||||
Yes | 4,266 | 19.4 | 0.96 | [0.92, 1.00] | * | |
No | 8,790 | 20.8 | ||||
Mental illness and substance abuse complexity | * | |||||
None | 8,736 | 20.0 | ||||
Only substance abuse | 998 | 21.3 | 1.08 | [1.00, 1.17] | * | |
Only mental illness | 2,536 | 21.2 | 1.08 | [1.02, 1.13] | ** | |
Both | 786 | 20.3 | 1.02 | [0.94, 1.12] | ||
Medication use§ | *** | |||||
No oral hypoglycemics | 2,839 | 30.7 | 1.59 | [1.51, 1.67] | *** | |
Oral hypoglycemics only | 6,956 | 21.5 | ||||
Insulin only | 2,004 | 14.7 | 0.63 | [0.60, 0.67] | *** | |
Oral hypoglycemics and insulin | 1,257 | 14.2 | 0.61 | [0.57, 0.65] | *** | |
Gender | ||||||
Women | 252 | 18.3 | 0.96 | [0.83, 1.10] | ||
Men | 12,804 | 20.4 | ||||
Race/Ethnicity | *** | |||||
White | 9,187 | 21.4 | ||||
African American | 2,143 | 18.5 | 0.90 | [0.85, 0.95] | *** | |
Latino | 458 | 18.8 | 0.95 | [0.86, 1.06] | ||
Other | 1,268 | 17.5 | 0.93 | [0.86, 1.00] | * | |
Age | *** | |||||
<55 years | 3,590 | 16.7 | ||||
55–64 years | 3,684 | 20.5 | 1.29 | [1.22, 1.36] | *** | |
65–75 years | 5,782 | 23.4 | 1.41 | [1.32, 1.51] | *** | |
Marital status | ||||||
Married | 7,990 | 20.4 | 0.96 | [0.92, 1.00] | ||
Other | 5,066 | 20.3 | ||||
Priority status FY1999 | ||||||
SC disability > 30% | 2,536 | 20.8 | 1.08 | [1.00, 1.18] | ||
SC disability < 20% | 2,677 | 20.2 | 1.05 | [0.97, 1.15] | ||
Non-SC, low income | 6,817 | 20.3 | ||||
Non-SC, high income | 1,026 | 20.2 | 0.99 | [0.92, 1.07] | ||
Dual VHA/Medicare use§ | *** | |||||
VHA/Medicare | 1,309 | 22.8 | 1.04 | [0.97, 1.12] | ||
Single | 6,937 | 22.1 | ||||
No Medicare enrollment | 4,810 | 17.8 | 0.94 | [0.89, 1.00] | * | |
Endocrinology visit§ | ** | |||||
Yes | 404 | 18.0 | 0.97 | [0.86, 1.08] | ||
No | 12,652 | 20.4 | ||||
Months between HbA1c tests | ||||||
Mean | 12.14 | 1.46 | [1.36, 1.57] | *** | ||
Hospitalization between HbA1c tests | *** | |||||
Macrovascular-related hospitalization | 1,359 | 25.0 | 1.41 | [1.34, 1.49] | *** | |
Other hospitalization | 2,513 | 24.8 | 1.00 | [1.00, 1.01] | ||
No hospitalization | 9,184 | 18.9 |
Sensitivity Analysis
Logistic regression on optimal glycemic control | ||||||
---|---|---|---|---|---|---|
FY1999 (N = 95,423) | FY2000 (N = 55,636, among those with ≥8% in FY1999 | |||||
AOR | 95% CI | Sig | AOR | 95% CI | Sig | |
Nondiabetes physical illness complexity | ||||||
Any cancer | 1.35 | [1.29, 1.41] | *** | 1.19 | [1.11, 1.28] | *** |
Gastrointestinal only (GI) | 1.42 | [1.31, 1.54] | *** | 1.11 | [0.98, 1.27] | |
Pulmonary only (PU) | 1.11 | [1.05, 1.17] | *** | 1.03 | [0.95, 1.13] | |
Musculoskeletal only (MS) | 1.26 | [1.21, 1.30] | *** | 1.13 | [1.07, 1.19] | *** |
Any two (GI, PU, MS) | 1.36 | [1.29, 1.43] | *** | 1.06 | [0.97, 1.15] | |
All three (GI, PU, MS) | 1.41 | [1.21, 1.65] | *** | 1.36 | [1.07, 1.74] | * |
No cancer, GI, PU, MS | ||||||
Diabetes-related complexity | ||||||
Macrovascular complications | ||||||
Yes | 0.95 | [0.92, 0.98] | *** | 0.93 | [0.89, 0.98] | ** |
No | ||||||
Microvascular complications | ||||||
Yes | 0.86 | [0.83, 0.88] | *** | 0.85 | [0.81, 0.89] | *** |
No | ||||||
Metabolic decompensation | ||||||
Yes | 0.70 | [0.68, 0.72] | *** | 1.03 | [0.98, 1.07] | |
No | ||||||
Mental illness and substance abuse complexity | ||||||
None | ||||||
Only substance abuse | 1.03 | [0.98, 1.09] | 1.03 | [0.95, 1.12] | ||
Only mental illness | 1.11 | [1.07, 1.15] | *** | 1.03 | [0.97, 1.09] | |
Both | 1.10 | [1.03, 1.16] | ** | 0.99 | [0.90, 1.08] | |
Hospitalization between HbA1c tests | ||||||
Macrovascular-related hospitalization | NA | 1.25 | [1.18, 1.32] | *** | ||
Other hospitalization | 1.00 | [1.00, 1.01] | ||||
No hospitalization |