Effects of Cancer Comorbidity on Disease Management: Making the Case for Diabetes Education (A Report from the SOAR Program)
Effects of Cancer Comorbidity on Disease Management: Making the Case for Diabetes Education (A Report from the SOAR Program)
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DOI：
10.1089/pop.2012.0028
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发表时间：
2013-02-01
影响因子：
2.5
通讯作者：
Mckoy, June M.
中科院分区：
文献类型：
--
作者：
Irizarry, Lauren;Li, Qijuan E.;Mckoy, June M.
与血糖正常的人相比，II型糖尿病患者被诊断为癌症的风险(相对风险[RR]=1.12-2.50)和死亡率(RR=1.4)都有所增加。生物机制，包括胰岛素的有丝分裂效应、高血糖和氧化应激增加，以及行为因素(如难以控制合并症)可能解释了风险增加的原因。为了研究共病对疾病管理的影响，作者将糖尿病-癌症共病患者的糖尿病教育利用与非癌症糖尿病患者的糖尿病教育利用进行了比较。糖尿病教育对预后的影响在糖尿病-癌症共病患者中进行了进一步评估。这项分析使用了行政索赔数据。研究人群包括60岁的个人以及商业和Medicare Advantage健康计划的成员，这些成员来自一个私人的全国性支付者数据数据库，但不包括服务患者和Medicaid患者的Medicare费用。这些人中的大多数都有资格获得糖尿病教育的报销。使用程序代码确定糖尿病教育利用情况。对3年时间段的结果进行评估。未患癌症的糖尿病患者(3.8%的使用率)和糖尿病-癌症共病患者(3.5%的使用率)在糖尿病教育利用方面差异不大。接受糖尿病教育的人更有可能每年进行多次糖化血红蛋白检测，更少的急诊科就诊，更少的住院，以及更低的护理相关成本(门诊和药房平均除外)。当糖尿病与癌症并存时，糖尿病的管理往往滞后，这使得糖尿病教育势在必行。《人口健康管理》2013；16：53-57。
Individuals with type II diabetes have an increased risk of cancer diagnosis (relative risk [RR] = 1.12-2.50) and mortality (RR=1.4) compared to normoglycemic individuals. Biologic mechanisms, including mitogenic effects of insulin, hyperglycemia, and increased oxidative stress, as well as behavioral factors (eg, difficulty managing the comorbidity) may explain the elevated risk. To investigate the effects of the comorbidity on disease management, the authors compared diabetes education utilization in individuals with diabetes-cancer comorbidity to utilization by individuals with diabetes in the absence of cancer. The effect of diabetes education on outcomes was further assessed in the subset of individuals with diabetes-cancer comorbidity. Administrative claims data were used for this analysis. The study population included individuals >60 years of age and members of both commercial and Medicare Advantage health plans from a private national database of payer data, but excluded Medicare fee for service and Medicaid patients. Most of these individuals were eligible to receive reimbursement for diabetes education. Diabetes education utilization was identified using procedure codes. Outcomes were assessed for a 3-year time period. There was little difference in diabetes education utilization between individuals with diabetes in the absence of cancer (3.8% utilization) and those with diabetes-cancer comorbidity (3.5% utilization). Individuals who receive diabetes education are more likely to have multiple HbA1c tests per year, fewer emergency department visits, fewer hospital admissions, and lower care-associated costs (except for outpatient and pharmacy averages). When diabetes coexists with cancer, management of diabetes often lags, making diabetes education an imperative. (Population Health Management 2013; 16:53-57.