RT Journal Article
SR Electronic
T1 Comorbidities, Utilization, and Quality of Care as Predictors of Diabetes Complications
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 157922
DO 10.3122/jabfm.2025.250185R1
VO 39
IS 1
A1 Liaw, Winston
A1 Adepoju, Omolola E
A1 Fuentes, Carlos G
A1 Luo, Jiangtao
A1 Glasheen, Bill
A1 King, Ben
A1 Kakadiaris, Ioannis
A1 Prewitt, Todd
A1 Womack, Pete
A1 Dobbins, Jess
A1 Woodard, LeChauncy
YR 2026
UL http://www.jabfm.org/content/39/1/157922.abstract
AB Objective To determine factors associated with diabetes complications, measured by the Diabetes Complications Severity Index (DCSI).Research Design and Methods This longitudinal analysis used insurer data (2016 – 2020) and included Medicare Advantage beneficiaries aged 65 and older with type 2 diabetes. The dependent variable was DCSI. Independent variables included year, demographics (age, sex, race/ethnicity, language, dual eligibility, rurality), comorbidities (Charlson (CCI) and Functional Comorbidity Indexes (FCI)), utilization (risk adjustment scores, emergency department, urgent care, outpatient, physician, inpatient, and pharmacy claims), and quality measures (hemoglobin A1c and blood pressure control). Four multilevel mixed-effects models were developed: demographics (model 1), comorbidities (model 2), utilization (model 3), and quality measures (model 4).Results We included 49,843 individuals. Model 1 showed a relationship between year (IRR=1.32, p<0.001, 2020 vs. 2016), sex (IRR=0.86, p<0.001, female vs. male), race/ethnicity (IRR=1.06, p<0.001, Black vs. white), dual eligibility (IRR=1.26, p<0.001 yes vs. no), and rurality (IRR=0.90, p<0.001, yes vs. no). CCI (IRR=1.18, p<0.001) and FCI (IRR=1.08, p<0.001), which share overlapping and distinct comorbidities with DCSI, were associated with higher DCSI. Emergency department visits (IRR=1.01, p<0.05) and physician visits (IRR=1.003, p< 0.05) were associated with higher DCSI. Not meeting the blood pressure quality measure was linked to higher DCSI (IRR=1.10, p<0.05), while hemoglobin A1c control was not.Conclusions Year, male sex, race/ethnicity, non-rural status, comorbidities, emergency department visits, and not meeting the blood pressure measure were linked to higher DCSI. Future research should develop strategies for high-risk groups in primary care settings.