Association of select preventative services and hospitalization in people with diabetes: diabetic foot exams confer a 33% reduction in hospitalization risk @APMA @RFUMS @ALPSlimb

Important work from Albright and Fleischer from Dartmouth and Rosalind Franklin University, respectively. This continues the important general data narrative suggesting that looking after the limb extends ulcer-free, hospital-free and activity-rich days.

Association of select preventative services and hospitalization in people with diabetes

Purpose: The purpose of this study was to assess the utilization rates and trends of preventative outpatient visits to providers in a population of people with diabetes, and evaluate which preventative services may offer protec- tion against poor outcomes (i.e. all-cause hospitalization).
Methods: The National Health and Nutrition Examination Survey (NHANES) was used to examine the relation- ship between select outpatient services and risk of all-cause hospitalization in people with diabetes. NHANES data from 2011 to 2016 were included. We assessed five outpatient services commonly recommended to prevent future complications in patients with diabetes: (1) routine examination from a physician (2) assessment of he- moglobin A1C (3) eye exam with pupil dilation (4) foot exam and (5) assessment from a diabetes specialist. Lo- gistic regression models were performed to assess the independent association of outpatient services used in the past 1 year, and hospitalization within that same year.

Results: The prevalence of diabetes within the NHANES population was 10.5% (n = 3054). Hospitalization was sig- nificantly more common among diabetics who were older, had lower income levels (i.e. under $20,000) and those who considered themselves in ‘fair’ or ‘poor health’. After adjustment for important covariates, patients who re- ceived a preventative foot exam within the last year (i.e. 1–4 times per year) were 33% less likely to be hospitalized within that year (OR 0.67, 95%CI 0.46, 0.96). Those visiting a diabetes specialist were 44% less likely to be hospitalized that year (OR 0.56, 95%CI 0.39, 0.82) if the visit was preventative in nature (i.e. occurred more than one year before the hospitalized event). No other outpatient services displayed an independent association with hospitalization. Conclusion: Outpatient Services were consistently being used annually by the diabetic population. Receiving a pre- ventative foot exam and visiting a diabetes specialist were associated with protection against hospitalization, resulting in a 33% and 44% decreased risk, respectively.

Research in context: Evidence before this study:

Current guidelines focus on preventative care measures to avert diabetes complications. In a 2018 national data- base study of approximately one-third of the Italian population, guidelines for prevention were not consistently being met among the diabetes population, however, patients who regularly received all the recommended pre- ventative measures experienced a 20% risk reduction in hospitalization. The study’s preventative measures in- cluded periodic lab monitoring including glycated hemoglobin and lipid profiles and dilated eye exams.

Added value of this study:

In our study, we used a national database representing the United States’ non-institutionalized population to identify the prevalence of prevention measures being utilized in adults with diabetes and further examine their relationship with all-cause hospitalization. Logistic regression analysis identified two preventative mea- sures with inconsistent utilization, however, when these measures were used according to guidelines, they con- tributed to a risk reduction in all-cause hospitalization.

Implications of all the available evidence:

Current preventative guidelines can contribute to a risk reduction in hospitalization among adults with diabetes. National guidelines and quality improvement initiatives should be aimed at improving the utilization of foot exams as a preventative measure and referral to a diabetes specialist before complications incur.

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