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Cited by 34Diabetes Management and EducationDiabetes Management and ResearchHealth Promotion and Cardiovascular Prevention

Characteristics of Insured Patients With Persistent Gaps in Diabetes Care Services: The Translating Research into Action for Diabetes (TRIAD) Study

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Gregg, Edward W., Karter, Andrew J., Gerzoff, Robert B., Safford, Monika, Brown, Arleen F., Tseng, Chien-Wen, Waitzfielder, Beth, Herman, William H. +4 more·2010·Medical Care
DOI 10.1097/mlr.0b013e3181bd4783PMC PMC4269465
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Abstract

BACKGROUND: Although preventing diabetes complications requires long-term management, little is known about which patients persistently fail to get recommended care. OBJECTIVE: To determine the frequency and correlates of persistent, long-term gaps in diabetes care. METHOD: : The study population included 8392 patients with diabetes. Patient surveys and medical records from 10 health plans over 3 years provided data on socioeconomic characteristics, access to care, social support, and mental and physical health, and diabetes preventive care services. We defined a "persistent gap" as a participant's missing a preventive care service for the entire 3 years. Services considered included hemoglobin A1c, cholesterol, and albuminuria tests, and foot and dilated eye examinations. RESULTS: Thirty percent of participants had at least 1 persistent gap. The most common gaps were lipid testing (11.6%), microalbuminuria testing (9.7%), and eye examinations (9.0%). Persistent gaps were 18% to 42% higher for young patients, lean persons, those with low income, employed persons, smokers, those with diabetes less than 5 years, and patients with none or 1 comorbid conditions. Sex, education, marital status, family demands, transportation, trust in physicians, and mental health were not associated with gaps in care. CONCLUSIONS: Persistent gaps in diabetes care are common even among insured patients. Patients with lower income, younger age, fewer years of diabetes, having fewer comorbidities, taking fewer medications, and poor health behaviors are vulnerable to persistent gaps in care and a group who warrant targeted interventions to improve preventive diabetes care.

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  • Patients' experience of health care is affected by perceived discrimination, resulting in distrust in the provider and, potentially, racial concordance with providers.

    “Patients' experience of health care is also affected by perceived discrimination, resulting distrust in the provider, and, potentially, racial concordance with providers [47-51].”

    From Prevalence of cardiovascular disease among Asian, Pacific Islander and multi-race populations in Hawai’i and California (2023) · cites this paper as [48]

    The Results discuss differences in missed diabetes services by patient race/ethnicity, while the Discussion says the study did not examine the relative impact of provider practices and perceptions on persistent lapses. Searches for discrimination, distrust, and racial concordance found no passage linking them to patients’ experience of care. (LLM, conf=0.76)

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Authors
Gregg, E. W., Karter, A. J., Gerzoff, R. B., Safford, M., Brown, A. F., Tseng, C.-W., Waitzfielder, B., Herman, W. H., Mangione, C. M., Selby, J. V., Thompson, T. J., & Dudley, R. A.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Kaiser Permanente (US)
  • University of Alabama at Birmingham (US)
  • University of California, Los Angeles (US)
  • University of Hawaiʻi at Mānoa (US)
  • Pacific Health Research and Education Institute (US)
Corresponding author
  • Gregg, Edward W.
  • Gerzoff, Robert B.
  • Herman, William H.
  • Thompson, Theodore J.
ORCID
Venue
Medical Care
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2010-01
Volume
48
Issue
1
Pages
31-37
ISSN
0025-7079 (ISSN-L)
DOI
10.1097/mlr.0b013e3181bd4783
PMC
PMC4269465
OpenAlex
W2030152347
Cited by
34
References
2
Citations by year
2026: 1 · 2025: 1 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 3 · 2017: 4 · 2016: 4 · 2014: 7
FWCI
1.94
Type
journal article
Language
en
Open access
Locations
  • Medical Care (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • Centers for Disease Control and Prevention
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK081796)
  • National Center for Chronic Disease Prevention and Health Promotion (U58 DP002641)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
preventive medicine, insured patients, health insurance, socioeconomic factors, low income, comorbidities, lipid testing, microalbuminuria, eye examination, foot examination, HbA1c, health care access, health behavior, diabetes complications
MeSH terms
Age Factors, Aged, Diabetes Mellitus, Female, Humans, Insurance Claim Review, Insurance, Health, Male, Middle Aged, Primary Prevention, Sex Factors, Smoking, Socioeconomic Factors, Time Factors, Health Behavior, Comorbidity, Body Mass Index, Insurance Coverage, Diabetes Complications

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