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Irregular follow-up, worsening HbA1c seen for low-income Japanese adults with diabetes
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Adults with untreated diabetes who have lower incomes are less likely to receive regular medical attention compared with higher-income individuals, and this discrepancy is linked to poorer glycemic measures, according to study findings from Japan.
“In addition to encouraging the initiation of physician visits, it is important to monitor physician visit patterns and clarify whether patients receive regular/continuous treatment using claims data,” Takumi Nishi, PhD, MPH, of the department of research planning and information management at Fukuoka Institute of Health and Environmental Sciences in Japan, and colleagues wrote. “However, as the proportion of people receiving continuous diabetic treatment in Japan is still low, it is important not only to initiate physician visits, but also to provide continuous treatment.”
Nishi and colleagues identified 650 patients with untreated diabetes who made regular physician visits and 2,311 who made irregular visits, which was defined as having a gap of more than 3 months between visits after an initial health checkup, from the Japanese Health Insurance Association. Any participant with an HbA1c level of more than 7% was considered to have “poor glycemic control.” The researchers wrote that the outcomes of interest were absolute increases in HbA1c levels of more than 0.5% and more than 1% and a relative increase of more than 20%.
A higher proportion of patients aged 55 to 59 years and 60 to 64 years was found in the regular visit group (27.1% and 33.1%, respectively) compared with those who made irregular visits (23.1% and 22%, respectively; P < .001). The proportion of patients aged 54 years or younger was greater in the irregular visit group compared with the regular visit group (P < .001). The researchers also found that irregular visits were negatively associated with monthly incomes between $2,000 and $2,999 (OR = 0.74; 95% CI, 0.56-0.98), $3,000 and $3,999 (OR = 0.63; 95% CI, 0.46-0.87) and $5,000 or more (OR = 0.58; 95% CI, 0.39-0.86).
Most patients in the irregular visit group (52.3%) had what the researchers called “relatively mild cases” or an HbA1c level of less than 7%. However, a higher percentage of individuals in the irregular visit group had increase in HbA1c of at least 0.5% during the study period compared with those in the regular visit group (26.4% vs. 10.8%; P < .001). This difference also held for an absolute rise in HbA1c of 1% (14.7% vs. 4%; P < .001) and a relative increase of 20% (8.1% vs. 2%; P < .001). Based on this information, the researchers observed an adjusted association between irregular visits and absolute HbA1c increases of 0.5% (OR = 2.04; 95% CI, 1.53-2.74) and 1% (OR = 3; 95% CI, 1.92-4.66) and a relative increase of 20% (OR = 3.09; 95% CI, 1.68-5.68).
“In Japan, universal health coverage has been achieved. ... Therefore, regardless of their income, Japanese people have equitable accessibility to health care for the same treatment,” the researchers wrote. “Nevertheless, the present results suggest that those with a lower income had impeded access to regular diabetes treatment.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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