In diabetes patients with co-morbid dementia, continued monitoring of HbA1c, cardiovascular risk, and diabetes complications can inform treatment decisions and minimize further declines in cognition, function, and quality of life. However, a clinically dominant, symptomatic, and discordant condition such as dementia may inhibit efforts to monitor diabetes in accordance with guidelines for older, complex patients. We examined the extent to which receipt of recommended diabetes monitoring differed for patients with and without co-morbid dementia, as well as the effect of other co-morbidities on diabetes monitoring in patients with co-morbid dementia.
Retrospective cohort study.
Secondary analysis of 2005–2006 claims and enrollment data for a 5% national random sample of Medicare beneficiaries.
288,805 Medicare fee-for-service beneficiaries with a diabetes diagnosis prior to 2006; 44,717 (16%) of whom had evidence of co-morbid dementia in claims.
We used established algorithms to determine whether patients received at least one HbA1c test, one LDL cholesterol test, and one annual eye exam in 2006, and construct variables representing co-morbidities common in diabetes, socio-demographics, and patterns of health care utilization.
In unadjusted and fully adjusted models, the presence of dementia reduced patients’ likelihood of receiving HbA1c tests, LDL tests, and eye exams, with effects being smallest for HbA1c tests. The effects of other co-morbidities on diabetes monitoring in patients with dementia varied by the nature of the co-morbidity and the specific test.
Dementia reduces the likelihood that diabetes patients received recommended annual monitoring for diabetes. More research is needed to understand reasons for reduced monitoring in this patient subgroup and how this impacts patient functioning, adverse events, and quality of life.