42-LB: Factors Associated with Use of Diabetes Self-Management Education and Support Programs in Newly Diagnosed Type 2 Diabetes Patients in Louisiana

Background: Prevalence of and factors associated with use of diabetes self-management education and support (DSME/S) programs in newly diagnosed type 2 diabetes (T2D) patients in Louisiana (LA) have not been fully evaluated.

Methods: We used EHRs from 3 hospital systems in LA (01/01/2013 to 10/31/2019). Eligible patients were 35-94 y-old with T2D based on ICD-codes, an antidiabetic drug prescription, an HbA1c ≥6.5%, an FPG ≥126, a 2-hr OGT ≥200, or random plasma glucose ≥200 mg/dL. New T2D was defined as entry of T2D diagnosis in the condition list occurring ≥1 y after first recorded office visit. DSME/S were searched by HCPCS codes G0108 and G0109. Logistic regressions compared differences between DSME/S vs. non-DSME/S group ≥180 days before the first recorded DSME/S.

Results: The prevalence of DSME/S use in T2D patients was 5.6% (18,139/313,242). In newly diagnosed T2D patients, the prevalence was 6.2% (8,918/137,629). Comparing to gender-, age- and race-matched non-DSME/S group, DSME/S group had worse clinical profiles, e.g., higher mean A1c and triglycerides, lower mean HDL, and higher obesity rate. Adjusted models showed self-pay patients were 70% less likely (OR 0.3, 95% CI 0.2-0.6) to use DMSE/S than Medicare beneficiaries. Current smokers were 2.6 times more likely (2.6, 1.8-3.7), but former smokers were 40% less likely (0.6, 0.5-0.7) to use DMSE/S than never smokers. Patients with hypolipidemic or antihypertensive drugs were 50% (1.5, 1.4-1.8) or 60% (1.6, 1.4-1.8) more likely to use DSME/S than those without the medications. Patients with A1c >6.5% were 3.9 times more likely (3.9, 3.4-4.6) to use DSMES/S than those with normal A1c. Obese patients were 60% more likely (1.6, 1.4-1.9), but hypertensive patients (SBP>130/DBP>80 mmHg) were 60% less likely to use DSME/S (0.4, 0.3-0.5).

Conclusion: Use of DSME/S is low in LA, and there are marked differences in using the service by insurance type, smoking status and diabetes risk control.