IMPACT OF NONCOMPLIANCE WITH DIABETES CARE GUIDELINES ON EMERGENCY ROOM VISITS AND HOSPITALIZATIONS IN A CALIFORNIA MEDICAID TYPE 2 DIABETES MELLITUS POPULATION

Purpose: To assess the impact of poor compliance with American Diabetes Association (ADA) guidelines for prevention and management of diabetes complications on emergency room (ER) visits and hospitalizations.

Method: California Medicaid eligibility and administrative data from 2002 through 2003 were used to identify patients.  Included patients were ≥40 years of age with two diagnoses of type 2 diabetes mellitus, or one diagnosis of type 2 diabetes and a prescription fill for an oral anti-diabetic medication. They were also continuously eligible for coverage in 2004.  Patients who did not have at least two glycosylated hemoglobin (HbA1c) tests, one eye exam, and one low-density lipoprotein-cholesterol (LDL-C) test in 2004 were classified as noncompliant with ADA guidelines.  Zero-inflated negative binomial (ZINB) regression models were used to estimate the relationship of noncompliance with ADA guidelines with two outcome variables in 2004, 1) number of ER visits,  and 2) number of hospitalizations.  

Result: Of 29,319 individuals who were identified as type 2 diabetes, 12,293 (42%) were noncompliant with ADA guidelines.  Approximately 12% and 14% of patients had at least one any cause ER visit and hospitalization, respectively.  After controlling variables for patients’ social demographic characteristics, health insurance status, and number of comorbidities, noncompliance with ADA guidelines was independently associated with increased number of ER visits (0.0517±0.010, p<0.0001) or increased number of hospitalizations (0.0627±0.006, p<0.0001).  Increased filling of oral anti-diabetic medication across classes was associated with increased number of ER visits (0.0045±0.0006, p<0.0001) and increased number of hospitalizations (0.0037±0.0005, p<0.0001).

Conclusion: Noncompliance with ADA guidelines was significantly associated with an increase in the number of ER visits and hospitalizations in a California Medicaid population with type 2 diabetes.  These results reinforce the importance of following ADA guidelines for prevention and management of diabetes complications to reduce poor health outcomes.