Lipid Testing Among Patients With Diabetes Who Receive Diabetes Care From Primary Care Physicians

Abstract

OBJECTIVE -To identify factors related to lipid testing among patients with diabetes who receive diabetes care from primary care physicians. RESEARCH DESIGN AND METHODS -North CarolinaMedicare claims were used to identify individuals with diabetes who received diabetes care from primary care physicians. Lipid testing was related to sociodemographic characteristics, comorbid conditions, physician specialty, and mortality.RESULTS -Based on Medicare claims from July 1997 through June 1999, 13,660 diabetic North Carolina residents with Medicare, 65-75 years of age, had received HbA 1c testing from a single primary care physician during at least three of four consecutive 6-month time intervals. During these 2 years, 31% had no lipid profile and 24% had only one lipid profile. Caucasians were 1.6 times more likely than African Americans to receive lipid profiles. Patients not receiving state Medicare assistance were 1.4 times more likely to have a lipid profile than the presumably lower-income patients receiving assistance. Patients with stroke and heart failure were less likely to receive lipid profiles. Those with no lipid profile were almost twice as likely to die from cardiovascular disease than those with at least two lipid profiles.CONCLUSIONS -Adherence to lipid testing recommendations by primary care physicians for elderly patients with diabetes has much room for improvement. The most vulnerable patients (African Americans, the economically disadvantaged, and the medically complex) are the least likely to receive lipid testing.

Sex Disparities in Treatment of Cardiac Risk Factors in Patients With Type 2 Diabetes

“…Lower adherence to treatment guidelines has been demonstrated in patients with diabetes who are older and whose conditions are more medically complicated, but sex-based differences were not examined (36,37). A Swedish study from 2004 examined the treatment of 9,375 patients with diabetes in the primary care setting and found that men had lower blood pressure, HbA 1c , and LDL levels (38), but there have been few other studies of this disparity in diabetes.…”

LDL-C goal Attainment Among Patients Newly Diagnosed With Coronary Heart Disease or Diabetes in a Commercial HMO

“…35 Last, we did not examine dyslipidemia versus LDL-C, and we cannot be certain that the lipid-lowering drug therapy was specifically used to treat elevated LDL-C. Finally, the use of claims data prohibited determination of the extent that patients could be splitting tablets.…”

The Need to Improve

“…n this issue of Diabetes Care, Massing et al (1) present the results of their review of Medicare claims from 13,660 diabetic patients who received regular outpatient care from a primary care physician (n ϭ 1,749). During a 24-month period, 31% received no lipid profile, 24% received only one lipid profile, and 45% of the diabetic patients received two or more lipid profiles.…”

“…The final clinical situation that has a practical application for diabetic patients is utilizing a direct LDL cholesterol measurement (2). The direct LDL cholesterol's Current Procedural Terminology (CPT) code is 83721, and this code was not used in the analysis by Massing et al (1). The practical application of a direct LDL cholesterol measurement is that the sample can be obtained in a nonfasting state, unlike the calculated LDL cholesterol, which requires at least a 10-h fast.…”