Diabetic Preventive Practices Are Variable Among Patient Populations

Lorena Baccaglini, PhD, DDS, MS

Patients with diabetes are encouraged to adhere to 4 diabetic care practices—daily blood glucose monitoring, foot checks, eye examinations with pupil dilation, and cholesterol check—in order prevent related complications.

Nevertheless, findings from a new study indicated that less than 1/3 of patients across the United States actually utilize all 4 practices concurrently. A higher percentage of patients followed only individual practices.

A team led by Lorena Baccaglini, PhD, DDS, MS, University of Nebraska Medical Center, used cross-sectional data from the 2017 Behavioral Risk Factor Surveillance System to identify and determine factors associated with preventative care practices in diabetic patients.

“A previous study of US trends in receiving diabetic clinical and self-care from 2001 to 2010 indicated that, although patients with diabetes showed a steady increase in self-monitoring of blood glucose, they had declines in annual eye examinations and self-foot checks,” Baccaglini and colleagues wrote.

“It is important to re-evaluate compliance with diabetic care practices after 7 years to determine whether these trends continue,” they continued.

The investigators acknowledged that patients may have individual preferences for certain diabetic care practices; as a result, assessing patterns of practices at the individual and overall level is valuable.

Adherence to Diabetic Preventative Care

The team included individuals ≥18 years old, but excluded those with pre-diabetes and only gestational diabetes, as well as individuals who were pregnant.

Thus, following implementation of inclusion and exclusion criteria, they proceeded to evaluate a total of 30,780 patients.

Of this total, nearly 30% had followed all 4 diabetic care practices. According to the investigators, this sub-population of patients corresponded with 3,720,346 or 28% of the US diabetic population

Among those who adhered to all preventative practices, over 35% were non-Hispanic participants, current insulin users, or individuals with retinopathy.

Adherence was lower among those who were younger, employed, current smokers, had consumed alcohol during the prior 30 days, had a lower BMI, had less than a high school education, or had no personal doctor.

However, the subgroup with the lowest percentage of patients who performed diabetic preventative practices was those without healthcare coverage (16.4%).

The investigators noted that such cost-related variables (having coverage for healthcare) were positively associated with diabetes care practices.

This association was strongest for adherence to practices that were considered more costly (annual eye examination, cholesterol check) versus less costly practices (daily blood glucose check, daily food check).

The study also evaluated adherence to specific and individual preventative measures.

“The percentage of individuals performing daily blood glucose checks was 61%, daily foot checks 60%, annual eye examination 69% and annual cholesterol check 93%,” the investigators wrote.

Even more, they reported that those who were underweight or had normal weight tended to adhere less strongly to daily foot checks (OR, 0.80; 95% CI, 0.69-0.93) and annual cholesterol checks (OR, 0.61; 95% CI, 0.46-0.78)—compared with those who were obese.

Current insulin use was strongly associated with performance of daily blood glucose checks (OR, 8.57; 95% CI, 7.35-9.98).

And finally, participants with lower education levels had an increased odds of performing daily glucose checks, yet a decreased odds of having an annual eye examination.

Explaining the Variability

As the results of the study indicate, variability in preventative care measures appears to be pervasive across the US and largely dependent on socio-economic and personal factors.

“The variability in diabetic care practices among different participants may be related to factors such as patients’ knowledge gap regarding certain practices, differential access to diabetic care, personal preferences, or disease severity,” Baccaglini and team wrote.

Understanding this variability and these gaps can potentially help clinicians develop strategies to optimize adherence among their patients.

“These findings suggest that stronger adherence may require diabetes care practice-specific strategies, such as improved accessibility or more comprehensive insurance coverage for clinic-based practices, and targeted early education for home-based practices,” the investigators wrote.

They also encouraged clinicians to highlight the importance of early adherence to their patients. As such, it may reduce complications and unnecessary costs, especially for high-risk subpopulations.

The study, “Variability in preventive care practices among US adults with diabetes mellitus,” was published online in BMJ Journals.