ArticleDiabetes care2022
Evolution of Clinical Complexity, Treatment Burden, Health Care Use, and Diabetes-Related Outcomes Among Commercial and Medicare Advantage Plan Beneficiaries With Diabetes in the U.S., 2006-2018.
Article in Diabetes care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 9 citations in OpenAlex.
- Predicting acute and chronic diabetes complications among adults newly diagnosed with diabetes: development and validation of dynamic risk prediction models.Nature communications · 2026Article
- Clinical risk phenotypes in diabetes and their associations with adverse cardiovascular events: A report from the Silesia Diabetes-Heart Project.Diabetic medicine : a journal of the British Diabetic Association · 2026Article
- Insulin Rationing Persists Despite Policy Changes: Repeated Cross-Sectional Studies, 2017 vs 2024.Journal of general internal medicine · 2025Article
- Improved Glycemic Outcomes in More Than 55 000 People of Medicare Age With Type 2 Diabetes Using a Mobile Diabetes App With Bluetooth-Connected Blood Glucose Meters.Journal of diabetes science and technology · 2024Article
- Longitudinal trajectories of glycemic control among U.S. Adults with newly diagnosed diabetes.Diabetes research and clinical practice · 2023Article
- Glucagon prescribing and prevention of hospitalization for hypoglycemia in a large health system.Diabetes research and clinical practice · 2023Article
- Disparities in limb preservation and associated socioeconomic burden among patients with diabetes and/or peripheral artery disease in the United States.Seminars in vascular surgery · 2023Review
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo characterize trends in clinical complexity, treatment burden, health care use, and diabetes-related outcomes among adults with diabetes. RESEARCH DESIGN AND
methodsWe used a nationwide claims database to identify enrollees in commercial and Medicare Advantage plans who met claims criteria for diabetes between 1 January 2006 and 31 March 2019 and to quantify annual trends in clinical complexity (e.g., active health conditions), treatment burden (e.g., medications), health care use (e.g., ambulatory, emergency department [ED], and hospital visits), and diabetes-related outcomes (e.g., hemoglobin A1c [HbA1c] levels) between 2006 and 2018.
resultsAmong 1,470,799 commercially insured patients, the proportion with ≥10 active health conditions increased from 33.3% (95% CI 33.1-33.4) in 2006 to 38.9% (38.8-39.1) in 2018 (P = 0.001) and the proportion taking three or more glucose-lowering medications increased from 11.6% (11.5-11.7) to 23.1% (22.9-23.2) (P = 0.007). The proportion with HbA1c ≥8.0% (≥64 mmol/mol) increased from 28.0% (27.7-28.3) in 2006 to 30.5% (30.2-30.7) in 2015, decreasing to 27.8% (27.5-28.0) in 2018 (overall trend P = 0.04). Number of ambulatory visits per patient per year decreased from 6.86 (6.84-6.88) to 6.19 (6.17-6.21), (P = 0.001) while ED visits increased from 0.26 (0.257-0.263) to 0.29 (0.287-0.293) (P = 0.001). Among 1,311,903 Medicare Advantage enrollees, the proportion with ≥10 active conditions increased from 51.6% (51.2-52.0) to 65.1% (65.0-65.2) (P < 0.001); the proportion taking three or more glucose-lowering medications was stable at 16.6% (16.3-16.9) and 18.1% (18.0-18.2) (P = 0.98), and the proportion with HbA1c ≥8.0% increased from 17.4% (16.7-18.1) to 18.6% (18.4-18.7) (P = 0.008). Ambulatory visits per patient per year remained stable at 8.01 (7.96-8.06) and 8.17 (8.16-8.19) (P = 0.23), but ED visits increased from 0.41 (0.40-0.42) to 0.66 (0.66-0.66) (P < 0.001).
conclusionsAmong patients with diabetes, clinical complexity and treatment burden have increased over time. ED utilization has also increased, and patients may be using ED services for low-acuity conditions.
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