Annual Wellness Visits Linked to Lower Risk of Amputation in Type 2 Diabetes

Jennifer Lobo, PhD

Medicare patients with type 2 diabetes who participate in annual wellness screenings were 36% less likely to require lower limb amputation, according to the results of a recent study.

An analysis of a decade’s worth of data from patients with Medicare in the “Diabetes Belt”, results of the study indicate patients who attended an annual wellness visit had 36% lower odds of requiring a major lower-extremity amputation in the same year than those who did not in analyses adjusted for adjusting for demographic factors, comorbidities, and major risk factors, including diabetic foot ulcers, neuropathy, peripheral vascular disease, and access to care factors. Additional insights from the study included an increased likelihood of requiring a major lower-extremity amputation within the “Diabetes Belt”, which encompasses 644 counties in the Appalachian and southeastern areas of the US, was 27% greater than in the surrounding areas.

“Our results confirmed our hypothesis that Annual Wellness Visits are associated with a reduced risk of major lower-extremity amputations, highlighting the importance of connecting patients to preventive care services,” said Jennifer Lobo, PhD, a researcher in UVA’s Department of Public Health Sciences.

Citing previous research suggesting patients in the “Diabetes Belt” region of the US had a greater rate of lower extremity amputations than surrounding areas, Lobo and colleagues from the UVA Department of Public Health Sciences sought to assess factors associated with an increased or decreased likelihood of amputations among patients from the region. To do so, investigators designed their study as an analysis of data from Medicare Fee-for-Service beneficiaries with type 2 diabetes within the region from 2006-2015. For the purpose of the current analysis, investigators sought to evaluate how attendance of annual wellness visits might influence risk of major lower extremity with adjustment for demographic factors, comorbidities and major risk factors, and access to care factors.

Investigators identified 1,034,525 patients with diabetes from the Diabetes Belt region and 1,018,583 patients with diabetes from surrounding counties for inclusion in their analyses. Patients from the Diabetes Belt region had a mean age of 75.5 (SE, 0.01) years, 44.3% were men, and 22.7% were non-Hispanic Black patients. Patients from the surrounding region had a mean age of 76.2 (SE, 0.01) years, 45.8% were men, and 15.0% were non-Hispanic Black patients.

Upon analysis, investigators found the odds of major lower-extremity amputations were 36% lower among patients who used annual wellness visits in the same year compared to those who did not in adjusted analyses. Additionally, results suggested patients in the Diabetes Belt region had approximately 27% greater odds of needing a major lower-extremity amputation than those with diabetes in the surrounding counties.

“While Annual Wellness Visits are a free visit for qualified Medicare beneficiaries, additional incentives or resources to overcome systemic access to care barriers are needed to support patient attendance,” Lobo said. “Patient education about the value of Annual Wellness Visits and preventive care could also help improve utilization of Annual Wellness Visits, hopefully reducing the rate of major amputations.”

This study, “Association between Annual Wellness Visits and Major Amputations among Medicare Beneficiaries in the Diabetes Belt,” was presented at the American Diabetes Association 2022 Scientific Sessions.