Diabetes care management patterns before and after a cancer diagnosis: A SEER-Medicare matched cohort study
Diabetes care management patterns before and after a cancer diagnosis: A SEER-Medicare matched cohort study
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DOI：
10.1002/cncr.32728
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发表时间：
2020-01-30
期刊：
影响因子：
6.2
通讯作者：
Safford, Monika M.
中科院分区：
文献类型：
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作者：
Pinheiro, Laura C.;Soroka, Orysya;Safford, Monika M.
糖尿病使癌症患者感染、住院和死亡的风险增加。当前研究的目的是描述癌症患者在癌症诊断前一年和癌症诊断后一年的糖尿病护理管理模式。作者假设，在诊断出癌症后，糖尿病护理会减少。方法使用与医疗保险索赔数据相关的监测、流行病学和最终结果（SEER）癌症登记处。作者纳入了2008年至2013年间诊断为偶发性、非转移性乳腺癌、前列腺癌或结直肠癌的65岁糖尿病受益人。对照组是SEER地区没有癌症的糖尿病医疗保险受益人。根据年龄、性别、Charlson合并症指数和糖尿病严重程度将病例与对照组相匹配。主要结局是12个月内接受的糖尿病治疗：1)糖化血红蛋白检测；2)眼科检查；3)低密度脂蛋白检测。采用差异中的差异（DID）方法，作者检查了癌症患者和对照组在诊断前后12个月的使用差异。为了避免捕获与诊断相关的测试而不是糖尿病管理，作者实施了90天的洗脱期（诊断前和/或诊断后45天）。结果共纳入32728例合并癌症的糖尿病患者和32728例匹配的非癌症对照。确诊后，与对照组相比，发现癌症患者的糖尿病护理使用率不高，但明显较低。癌症患者在诊断前后12个月的血红蛋白A1c检测（DID, 2.4%, 95% CI, 1.7%-3.0%）、低密度脂蛋白检测（DID, 4.3%, 95% CI, 3.6%-5.0%）和所有糖尿病指标（DID, 2.7%, 95% CI, 1.8%-3.5%）均有较大下降。结论与对照组相比，癌症患者在诊断后一年内糖尿病护理使用较少。了解和解决这一问题的原因可能会改善这一人群的预后。
Background Diabetes places patients with cancer at an increased risk of infections, hospitalizations, and mortality. The objective of the current study was to characterize diabetes care management patterns among patients with cancer in the year before and, separately, after cancer diagnosis. The authors hypothesized that diabetes care declines after a diagnosis of cancer. Methods The Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare claims data was used. The authors included diabetic beneficiaries aged >= 65 years who were diagnosed with incident, nonmetastatic breast, prostate, or colorectal cancer between 2008 and 2013. Controls were diabetic Medicare beneficiaries in SEER regions who did not have cancer. Cases were matched to controls based on age, sex, Charlson Comorbidity Index, and diabetes severity. Primary outcomes were diabetes care received over 12 months: 1) hemoglobin A1c testing; 2) eye examination; and 3) low-density lipoprotein testing. Using a difference-in-difference (DID) approach, the authors examined use differences 12 months before to after diagnosis for patients with cancer and controls. To avoid capturing testing related to diagnosis and not diabetes management, the authors implemented a 90-day washout period (45 days before and/or after diagnosis). Results A total of 32,728 diabetic patients with cancer and 32,728 matched noncancer controls were included. After diagnosis, patients with cancer were found to have modest, but significantly lower, rates of diabetes care use compared with controls. Patients with cancer had greater declines in hemoglobin A1c testing (DID, 2.4%; 95% CI, 1.7%-3.0%), low-density lipoprotein testing (DID, 4.3%; 95% CI, 3.6%-5.0%), and receipt of all diabetes indicators (DID, 2.7%; 95% CI, 1.8%-3.5%) 12 months before to after diagnosis. Conclusions Compared with controls, less diabetes care use was observed among patients with cancer in the year after diagnosis. Understanding and addressing the reasons for this may improve outcomes in this population.