OBJECTIVE Medicare Advantage (MA), Medicare’s managed care program, is quickly expanding, yet little is known about diabetes care quality delivered under MA compared with traditional fee-for-service (FFS) Medicare. RESEARCH DESIGN AND METHODS This was a retrospective cohort study of Medicare beneficiaries ≥65 years old enrolled in the Diabetes Collaborative Registry from 2014 to 2019 with type 2 diabetes treated with one or more antihyperglycemic therapies. Quality measures, cardiometabolic risk factor control, and antihyperglycemic prescription patterns were compared between Medicare plan groups, adjusted for sociodemographic and clinical factors. RESULTS Among 345,911 Medicare beneficiaries, 229,598 (66%) were enrolled in FFS and 116,313 (34%) in MA plans (for ≥1 month). MA beneficiaries were more likely to receive ACE inhibitors/angiotensin receptor blockers for coronary artery disease, tobacco cessation counseling, and screening for retinopathy, foot care, and kidney disease (adjusted P ≤ 0.001 for all). MA beneficiaries had modestly but significantly higher systolic blood pressure (+0.2 mmHg), LDL cholesterol (+2.6 mg/dL), and HbA1c (+0.1%) (adjusted P < 0.01 for all). MA beneficiaries were independently less likely to receive glucagon-like peptide 1 receptor agonists (6.9% vs. 9.0%; adjusted odds ratio 0.80, 95% CI 0.77–0.84) and sodium–glucose cotransporter 2 inhibitors (5.4% vs. 6.7%; adjusted odds ratio 0.91, 95% CI 0.87–0.95). When integrating Centers for Medicare and Medicaid Services-linked data from 2014 to 2017 and more recent unlinked data from the Diabetes Collaborative Registry through 2019 (total N = 411,465), these therapeutic differences persisted, including among subgroups with established cardiovascular and kidney disease. CONCLUSIONS While MA plans enable greater access to preventive care, this may not translate to improved intermediate health outcomes. MA beneficiaries are also less likely to receive newer antihyperglycemic therapies with proven outcome benefits in high-risk individuals. Long-term health outcomes under various Medicare plans requires surveillance.

中文翻译：

---

参加 Medicare Advantage 的老年人的糖尿病护理与传统 Medicare 按服务收费计划的比较：糖尿病合作登记处

目标 Medicare Advantage (MA) 是 Medicare 的管理式医疗计划，正在迅速扩大，但与传统的按服务收费 (FFS) Medicare 相比，人们对 MA 下提供的糖尿病护理质量知之甚少。研究设计和方法 这是一项回顾性队列研究，对象为 2014 年至 2019 年在糖尿病合作登记处登记的年龄≥65 岁、接受一种或多种抗高血糖疗法治疗的 2 型糖尿病的医疗保险受益人。对医疗保险计划组之间的质量测量、心脏代谢危险因素控制和降血糖处方模式进行比较，并根据社会人口统计学和临床​​因素进行调整。结果 在 345,911 名医疗保险受益人中，229,598 人 (66%) 参加了 FFS，116,313 人 (34%) 参加了 MA 计划（≥1 个月）。MA 受益人更有可能接受 ACE 抑制剂/血管紧张素受体阻滞剂治疗冠状动脉疾病、戒烟咨询以及视网膜病变、足部护理和肾脏疾病筛查（所有调整后 P ≤ 0.001）。MA 受益人的收缩压 (+0.2 mmHg)、LDL 胆固醇 (+2.6 mg/dL) 和 HbA1c (+0.1%) 略有升高（调整后 P < 0.01）。MA 受益人独立接受胰高血糖素样肽 1 受体激动剂（6.9% vs. 9.0%；调整后比值比 0.80，95% CI 0.77–0.84）和钠-葡萄糖协同转运蛋白 2 抑制剂（5.4% vs. 6.7%；调整后比值比 0.80，95% CI 0.77–0.84）的可能性较小。调整后的比值比 0.91，95% CI 0.87–0.95）。当整合 2014 年至 2017 年医疗保险和医疗补助服务中心的相关数据以及截至 2019 年糖尿病合作登记处的最新非关联数据（总计 N = 411,465）时，这些治疗差异仍然存在，包括在已确诊心血管和肾脏疾病的亚组中。结论 虽然 MA 计划使人们能够更多地获得预防性护理，但这可能不会转化为改善中期健康结果。MA 受益人也不太可能接受新的抗高血糖疗法，这些疗法在高危人群中已被证明有效果。各种医疗保险计划下的长期健康结果需要监测。结论 虽然 MA 计划使人们能够更多地获得预防性护理，但这可能不会转化为改善中期健康结果。MA 受益人也不太可能接受新的抗高血糖疗法，这些疗法在高风险个体中已被证明有效果。各种医疗保险计划下的长期健康结果需要监测。结论 虽然 MA 计划使人们能够更多地获得预防性护理，但这可能不会转化为改善中期健康结果。MA 受益人也不太可能接受新的抗高血糖疗法，这些疗法在高危人群中已被证明有效果。各种医疗保险计划下的长期健康结果需要监测。