Poor glycemic control increases the risk of long-term complications, while overtreatment exposes patients to hypoglycemia. In this study, we examined the rates and correlates of potential overtreatment and undertreatment among adults (≥18 years) with diabetes using OptumLabs® Data Warehouse, an administrative claims dataset of commercial and Medicare Advantage enrollees across the U.S. Patient comorbidities were ascertained in 2014. Demographics, HbA1c, glucose-lowering medications, and attributed provider (internal medicine [IM], family medicine [FM], endocrinology) were ascertained in 2015. Patients were classified as potentially over- or undertreated based on their HbA1c, treatment regimen, and clinical complexity.

The study cohort was comprised of 215,429 adults with diabetes; mean age 65.0 years, 59.4% white, 4.2% with type 1 diabetes, 23.1% ≥75 years, and 12.1% clinically complex. Overall, 21.3% were undertreated (22.7% low complexity, 10.9% high complexity) and 7.7% overtreated (5.4% low complexity, 23.8% high complexity).

Younger age, male sex, black/Hispanic race/ethnicity, type 1 diabetes, FM management, and low clinical complexity were associated with glycemic undertreatment (Table). Younger age, male sex, white/Asian race/ethnicity, type 1 diabetes, endocrine management, and high clinical complexity were associated with glycemic overtreatment.

R.G. McCoy: None. K.J. Lipska: Consultant; Self; Health Services Advisory Group (HSAG). Research Support; Self; National Institute on Aging. Other Relationship; Self; Centers for Medicare and Medicaid Services. H. Van Houten: None. N. Shah: None.


American Association of Retired Persons; OptumLabs; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)

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