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Patients with diabetes, rheumatoid arthritis receive less HbA1c testing
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In older adults with diabetes, comorbid rheumatoid arthritis predicted lower rates of HbA1c testing but slightly higher rates of LDL testing, according to recent study results.
From a sample of Medicare patients, researchers identified 256,331 diabetic beneficiaries aged 65 years and older. Researchers used a validated algorithm to determine that 5,572 (2.2%) also had rheumatoid arthritis (RA). They then determined whether the patients had received guideline-recommended HbA1c and LDL testing.
The effect of RA on the likelihood of receiving testing, adjusted for baseline sociodemographics, comorbidities and health care utilization, was examined using multivariate logistic regression. Researchers found that diabetic patients with RA were more likely to have baseline cardiovascular disease (28% more congestive heart failure), as well as diabetes complications from kidney disease (19% greater), lower extremity ulcers (77% greater) and peripheral vascular disease (32% more) than those without RA. The only diabetes complication seen less frequently in patients with RA was diabetic eye disease (18% less).
Patients with RA were significantly less likely to receive the recommended two HbA1c tests per year (OR=0.84; 95% CI, 0.80-0.89) but slightly more likely to receive LDL testing (OR=1.08; 95% CI, 1.10-1.16) compared with diabetic patients without RA.
“[HbA1c] testing is generally perceived as a diabetes care goal but not an RA priority, which might explain lower testing rates in patients who also have competing RA care needs,” the researchers said. “Our findings support conceptualizing RA and diabetes on a concordant risk pathway to improve screening for complications and diabetes-monitoring performance in patients with RA.”
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