Background: Specific outpatient services have been recommended to prevent diabetes complications. The purpose of this study is to assess the utilization and trends of preventative outpatient visits to providers in a population of people with diabetes, and evaluate which preventative services may offer the most protection against poor outcomes.

Methods: The National Health and Nutrition Examination Survey (NHANES) was used to examine the relationship between select outpatient services and risk of all-cause hospitalization in people with diabetes. We assessed five outpatient services commonly recommended: (1) examination from a physician (2) assessment of hemoglobin A1C (3) eye exam with pupil dilation (4) foot exam and (5) assessment from a diabetes specialist. Logistic regression models were performed to assess the independent association of outpatient services used in the past 1 year, and hospitalization within that same year.

Results: Ninety-nine percent of patients with diabetes engaged in at least one outpatient service every year between 2011 and 2016. Patients receiving a preventative foot exam within the last year experienced a protective effect against hospitalization within that year (OR 0.67, 95%CI 0.46, 0.96). Visiting a diabetes specialist produced a protective effect against hospitalization (OR 0.56, 95%CI 0.39, 0.82) if the visit occurred more than one year before the hospitalized event. No other outpatient services were associated with hospitalization. Findings of the final regression model were robust to sensitivity analysis.

Conclusion: Outpatient Services are consistently being used annually by the diabetic population, however, the services that show the most protection against all-cause hospitalization are utilized the least. Receiving a preventative foot exam and visiting a diabetes specialist were most effective at protecting patients from all-cause hospitalization, resulting in a 33% and 44% decreased risk, respectively.


R.H. Albright: None. A.E. Fleischer: None.

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