Although prevention of complications in diabetes requires careful control over many years, little is known about which patients persistently fail to get recommended care.
To determine the frequency and correlates of persistent long-term gaps in diabetes care.
Patient surveys and reviews of medical records were used to assess preventive care services for diabetes among 8392 patients who were continuously enrolled in 10 US managed care plans from 1999 to 2002. Demographic and socioeconomic characteristics, access to care, social support, and mental and physical health were determined by interview. Five preventive care services of diabetes care (testing of hemoglobin A1c, cholesterol, and albuminuria, dilated eye exams, and foot exams) were assessed by survey and chart abstraction for a 3-year period (1999–2002). We defined a “persistent lapse” as a participant’s missing a preventive care service for the entire 3 years.
In all, 70% of patients had no persistent lapses, 22% had 1, 6% had 2, and 2% had ≥ 3. Persistent lapses occurred most often for lipid testing (11.6%), microalbuminuria testing (9.7%), and eye exams (9.0%), but less frequently for foot exams (6.9%) and A1c tests (4.2%). In multivariate analyses, the odds of a persistent lapse in care was 42% higher for young (age 18–44) than middle aged persons and 26% higher among lean than very obese persons. In addition, the odds of a persistent lapse was 26% higher for those of low income, 29% higher among employed persons, 18% higher for smokers, 27% higher in those with fewer than 5 years of diabetes than those with > 15 years, and 42% higher for persons with zero or 1 comorbid conditions (compared to ≥ 3). In addition, non-Hispanic blacks were particularly likely to miss lipid tests (15.3%) and those not taking medications were especially likely to miss foot exams (7.1%), A1c tests (10.6%), and proteinuria tests (10.8%). Sex, education, marital status, family demands, transportation, trust in physicians, and mental health were not associated with lapses in care.
Even in an insured cohort, 3 in 10 participants had 1 or more persistent lapses in diabetes care. Patients with lower income, younger age, having fewer co-morbidities, taking fewer medications and poor health behaviors are particularly vulnerable to persistent lapses in care and a group who warrant targeted interventions to improve preventive diabetes care.