Providing diabetes care that does not meet guidelines increases health costs for patients

Key takeaways:

• From 2016 to 2018, about 12% of patients with diabetes received care that did not align with American Diabetes Association guidelines.
• The annual burden of improper diabetes care may be as high as $16 billion.

Patients with diabetes who received care that did not adhere to the American Diabetes Association, or ADA, guidelines spent an extra $4,031 in annual health care costs compared with the prior year, a recent study found.

According to Marjan Zakeri, MD, a PhD candidate at the University of Houston College of Pharmacy, and colleagues, guidelines from the ADA advocate for appropriate prescriptions of antihyperglycemics, lifestyle modifications, preventive care measures, screenings and treatment of diabetes-related complications.

However, despite the potential of health risks from nonadherent care and evidence supporting current guidelines, “the prevalence of nonadherent care among patients with [type 2 diabetes] remains high,” Zakeri and colleagues wrote in the American Journal of Managed Care.

“We demonstrated in our previous study that nonadherence to ADA standards of [type 2 diabetes] care guidelines ranged from about 24% to 44% for five types of care: lifestyle management, immunization, pharmacologic therapies, physical examinations, and laboratory tests,” they wrote.

To learn more, Zakeri and colleagues conducted a retrospective cross-sectional cohort study to estimate the economic impact of nonadherence to ADA-recommended diabetes care. The researchers evaluated 2016 to 2018 Medical Expenditure Panel Survey data on 1,619 adults, who represented 15,781,346 individuals. They used a 1:1 propensity score model to match patients who received adherent and nonadherent care.

Guideline-adherent care was defined as adherence to at least nine of 10 processes of type 2 diabetes care, which included HbA1c and cholesterol tests, medications for hypertension and medication adherence to antihyperglycemics. Nonadherent care was defined as adherence to six or fewer processes of care.

Zakeri and colleagues reported that about 12.17% of patients with diabetes received nonadherent care and 51.02% received adherent care. In the first year, adherence to annual HbA1c tests was 30.5%, whereas cholesterol test adherence was 21.9%.

Overall, those who received nonadherent care spent $4,031 more in total annual health care expenditures compared with their baseline year. An analysis adjusted for imbalanced factors further showed that nonadherent care was associated with a mean increase of $3,470 from baseline costs.

Patients who received adherent care, meanwhile, had a $128 lower total annual health care expenditure compared with their baseline year.

Zakeri and colleagues wrote that the prevalence of types 2 diabetes in the U.S., combined with the prevalence of nonadherent care, suggests that “the annual burden of nonadherent diabetes care could be as large as $16 billion.”

They added that the findings highlight “the potential cost-saving aspect of adherence to [type 2 diabetes] guidelines.”

“Our findings can be used as a basis for implementation of cost-saving managed care programs to improve long-term adherence to [type 2 diabetes] guidelines,” the researchers wrote.

An example of one such program is a team-based approach incorporating clinical pharmacists, according to Zakeri and colleagues. A recent study, they added, showed the intervention led to a decrease in HbA1c levels.

“The clinical pharmacists were responsible for managing therapy for [type 2 diabetes], as well as for hypertension and hypercholesterolemia, to reach optimal clinical goals,” Zakeri and colleagues wrote. “In addition, pharmacists could address other care gaps including medication adherence, refills, vaccinations, screenings, and lifestyle modifications.”