Table 3.
Optimal Glycemic Control in FY2000 by CIC among VHA Clinic Users with Diabetes and with Less Than Optimal Control in FY1999
| With optimal glycemic control | Logistic regression on optimal glycemic control | |||||
|---|---|---|---|---|---|---|
| N | % | Sig | AOR | 95% CI | Sig | |
| All | 13,056 | 20.4 | ||||
| Nondiabetes physical illness complexity | *** | |||||
| Any cancer | 1,884 | 24.1 | 1.24 | [1.17, 1.32] | *** | |
| Gastrointestinal only (GI) | 411 | 23.1 | 1.31 | [1.17, 1.47] | *** | |
| Pulmonary only (PU) | 875 | 20.7 | 1.08 | [0.99, 1.17] | ||
| Musculoskeletal only (MS) | 3,080 | 21.4 | 1.17 | [1.12, 1.23] | *** | |
| Any two (GI, PU, MS) | 1,163 | 22.8 | 1.20 | [1.12, 1.30] | *** | |
| All three (GI, PU, MS) | 127 | 26.0 | 1.34 | [1.09, 1.65] | ** | |
| No cancer, GI, PU, MS | 5,516 | 18.2 | ||||
| Diabetes-related complexity | ||||||
| Macrovascular complications | ||||||
| Yes | 5,954 | 20.7 | 0.90 | [0.86, 0.94] | *** | |
| No | 7,102 | 20.1 | ||||
| Microvascular complications | *** | |||||
| Yes | 4,394 | 18.5 | 0.88 | [0.84, 0.92] | *** | |
| No | 8,662 | 21.4 | ||||
| Metabolic decompensation | *** | |||||
| Yes | 4,266 | 19.4 | 0.96 | [0.92, 1.00] | * | |
| No | 8,790 | 20.8 | ||||
| Mental illness and substance abuse complexity | * | |||||
| None | 8,736 | 20.0 | ||||
| Only substance abuse | 998 | 21.3 | 1.08 | [1.00, 1.17] | * | |
| Only mental illness | 2,536 | 21.2 | 1.08 | [1.02, 1.13] | ** | |
| Both | 786 | 20.3 | 1.02 | [0.94, 1.12] | ||
| Medication use§ | *** | |||||
| No oral hypoglycemics | 2,839 | 30.7 | 1.59 | [1.51, 1.67] | *** | |
| Oral hypoglycemics only | 6,956 | 21.5 | ||||
| Insulin only | 2,004 | 14.7 | 0.63 | [0.60, 0.67] | *** | |
| Oral hypoglycemics and insulin | 1,257 | 14.2 | 0.61 | [0.57, 0.65] | *** | |
| Gender | ||||||
| Women | 252 | 18.3 | 0.96 | [0.83, 1.10] | ||
| Men | 12,804 | 20.4 | ||||
| Race/Ethnicity | *** | |||||
| White | 9,187 | 21.4 | ||||
| African American | 2,143 | 18.5 | 0.90 | [0.85, 0.95] | *** | |
| Latino | 458 | 18.8 | 0.95 | [0.86, 1.06] | ||
| Other | 1,268 | 17.5 | 0.93 | [0.86, 1.00] | * | |
| Age | *** | |||||
| <55 years | 3,590 | 16.7 | ||||
| 55–64 years | 3,684 | 20.5 | 1.29 | [1.22, 1.36] | *** | |
| 65–75 years | 5,782 | 23.4 | 1.41 | [1.32, 1.51] | *** | |
| Marital status | ||||||
| Married | 7,990 | 20.4 | 0.96 | [0.92, 1.00] | ||
| Other | 5,066 | 20.3 | ||||
| Priority status FY1999 | ||||||
| SC disability > 30% | 2,536 | 20.8 | 1.08 | [1.00, 1.18] | ||
| SC disability < 20% | 2,677 | 20.2 | 1.05 | [0.97, 1.15] | ||
| Non-SC, low income | 6,817 | 20.3 | ||||
| Non-SC, high income | 1,026 | 20.2 | 0.99 | [0.92, 1.07] | ||
| Dual VHA/Medicare use§ | *** | |||||
| VHA/Medicare | 1,309 | 22.8 | 1.04 | [0.97, 1.12] | ||
| Single | 6,937 | 22.1 | ||||
| No Medicare enrollment | 4,810 | 17.8 | 0.94 | [0.89, 1.00] | * | |
| Endocrinology visit§ | ** | |||||
| Yes | 404 | 18.0 | 0.97 | [0.86, 1.08] | ||
| No | 12,652 | 20.4 | ||||
| Months between HbA1c tests | ||||||
| Mean | 12.14 | 1.46 | [1.36, 1.57] | *** | ||
| Hospitalization between HbA1c tests | *** | |||||
| Macrovascular-related hospitalization | 1,359 | 25.0 | 1.41 | [1.34, 1.49] | *** | |
| Other hospitalization | 2,513 | 24.8 | 1.00 | [1.00, 1.01] | ||
| No hospitalization | 9,184 | 18.9 | ||||
Percent with and predictors of optimal glycemic control in FY2000 (N = 64,156). Based on VHA clinic users with diabetes as of FY1999, aged under 75 years, enrolled in VHA or Medicare fee-for-service, and alive as of the end of FY2000 and having HbA1c values ≥7% in FY1999. Optimal glycemic control defined as HbA1c values lower than 7%. Logistic regression includes intercept as well. The symbol “§” represents measurement of variables in the 120 days before the last HbA1c test in FY1999.
HbA1c Glycosylated hemoglobin, SC service-connected, FY fiscal year, VHA Veterans Health Administration, GI gastrointestinal diagnoses, PU pulmonary diagnoses, MS musculoskeletal diagnoses, AOR adjusted odds ratio, CI confidence interval
*0.01 ≤ P < 0.05
** 0.001 ≤ P < 0.01
***P < 0.001