OBJECTIVE To characterize trends in clinical complexity, treatment burden, health care use, and diabetes-related outcomes among adults with diabetes. RESEARCH DESIGN AND METHODS We used a nationwide claims database to identify enrollees in commercial and Medicare Advantage plans who met claims criteria for diabetes between 1 January 2006 and 31 March 2019 and to quantify annual trends in clinical complexity (e.g., active health conditions), treatment burden (e.g., medications), health care use (e.g., ambulatory, emergency department [ED], and hospital visits), and diabetes-related outcomes (e.g., hemoglobin A1c [HbA1c] levels) between 2006 and 2018. RESULTS Among 1,470,799 commercially insured patients, the proportion with ≥10 active health conditions increased from 33.3% (95% CI 33.1–33.4) in 2006 to 38.9% (38.8–39.1) in 2018 (P = 0.001) and the proportion taking three or more glucose-lowering medications increased from 11.6% (11.5–11.7) to 23.1% (22.9–23.2) (P = 0.007). The proportion with HbA1c ≥8.0% (≥64 mmol/mol) increased from 28.0% (27.7–28.3) in 2006 to 30.5% (30.2–30.7) in 2015, decreasing to 27.8% (27.5–28.0) in 2018 (overall trend P = 0.04). Number of ambulatory visits per patient per year decreased from 6.86 (6.84–6.88) to 6.19 (6.17–6.21), (P = 0.001) while ED visits increased from 0.26 (0.257–0.263) to 0.29 (0.287–0.293) (P = 0.001). Among 1,311,903 Medicare Advantage enrollees, the proportion with ≥10 active conditions increased from 51.6% (51.2–52.0) to 65.1% (65.0–65.2) (P < 0.001); the proportion taking three or more glucose-lowering medications was stable at 16.6% (16.3–16.9) and 18.1% (18.0–18.2) (P = 0.98), and the proportion with HbA1c ≥8.0% increased from 17.4% (16.7–18.1) to 18.6% (18.4–18.7) (P = 0.008). Ambulatory visits per patient per year remained stable at 8.01 (7.96–8.06) and 8.17 (8.16–8.19) (P = 0.23), but ED visits increased from 0.41 (0.40–0.42) to 0.66 (0.66–0.66) (P < 0.001). CONCLUSIONS Among patients with diabetes, clinical complexity and treatment burden have increased over time. ED utilization has also increased, and patients may be using ED services for low acuity conditions.

中文翻译：

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2006-2018 年美国糖尿病商业和医疗保险优势计划受益人的临床复杂性、治疗负担、医疗保健使用和糖尿病相关结果的演变


目的 描述成人糖尿病患者的临床复杂性、治疗负担、医疗保健使用和糖尿病相关结局的趋势。研究设计和方法我们使用全国性索赔数据库来识别2006年1月1日至2019年3月31日期间符合糖尿病索赔标准的商业和医疗保险优惠计划的参保者，并量化临床复杂性（例如，活跃的健康状况）、治疗的年度趋势2006 年至 2018 年间的负担（例如药物）、医疗保健使用（例如门诊、急诊科 [ED] 和医院就诊）以及糖尿病相关结果（例如糖化血红蛋白 [HbA1c] 水平）。 结果 1,470,799 项商业研究在参保患者中，患有≥10种活跃健康状况的比例从2006年的33.3%（95% CI 33.1-33.4）增加到2018年的38.9%（38.8-39.1）（P = 0.001），并且服用三种或三种以上降糖药物的比例药物治疗从 11.6% (11.5–11.7) 增加到 23.1% (22.9–23.2) (P = 0.007)。 HbA1c≥8.0%（≥64 mmol/mol）的比例从2006年的28.0%（27.7~28.3）上升至2015年的30.5%（30.2~30.7），又下降至2018年的27.8%（27.5~28.0）（总体趋势） P = 0.04）。每名患者每年门诊就诊次数从 6.86 (6.84–6.88) 减少到 6.19 (6.17–6.21)，(P = 0.001)，而急诊就诊次数从 0.26 (0.257–0.263) 增加到 0.29 (0.287–0.293) (P = 0.001）。在 1,311,903 名 Medicare Advantage 参保者中，患有 ≥10 种活跃病症的比例从 51.6% (51.2–52.0) 增加到 65.1% (65.0–65.2) (P < 0.001)；服用三种或以上降糖药物的比例稳定在16.6%（16.3-16.9）和18.1%（18.0-18.2）（P=0.98），HbA1c≥8.0%的比例从17.4%（16.7-18.1）增加) 至 18.6% (18.4–18.7) (P = 0.008)。 每名患者每年的门诊次数稳定在 8.01 (7.96–8.06) 和 8.17 (8.16–8.19) (P = 0.23)，但急诊就诊次数从 0.41 (0.40–0.42) 增加到 0.66 (0.66–0.66) (P <) 0.001）。结论 在糖尿病患者中，临床复杂性和治疗负担随着时间的推移而增加。急诊室的利用率也有所增加，患者可能会因病情严重程度较低而使用急诊室服务。