Table 4.
Persistence with RAI and clinical outcomes during the 12-month follow-up in patients with T2D who added RAI to their basal insulin regimen.
| Characteristic | Change in A1C from baseline to 12-month follow-up | Severe hypoglycemia during 12-month follow-up | |||
|---|---|---|---|---|---|
|
| |||||
| All (N = 3,927)* | Beta coefficient | SE | p-value | Adjusted OR(95% CI) | p-value |
| RAI persistent | |||||
| Yes | −0.24 | 0.10 | 0.013 | 0.73 (0.53–0.99) | 0.046 |
| No | Ref. | Ref. | |||
| Gender | |||||
| Female | 0.02 | 0.08 | 0.829 | 0.99 (0.77–1.26) | 0.907 |
| Male | Ref. | Ref. | |||
| Race | |||||
| African American | 0.25 | 0.11 | 0.019 | 1.55 (1.12–2.13) | 0.007 |
| Other | 0.24 | 0.13 | 0.078 | 0.88 (0.56–1.39) | 0.587 |
| White | Ref. | Ref. | |||
| Age group, years | |||||
| 65–74 | Ref. | Ref. | |||
| ≥75 | 0.04 | 0.08 | 0.621 | 1.19 (0.93–1.54) | 0.173 |
| United States region | |||||
| Midwest | −0.30 | 0.15 | 0.042 | 0.99 (0.67–1.45) | 0.950 |
| South | −0.03 | 0.11 | 0.755 | 0.87 (0.61–1.26) | 0.464 |
| Northeast, west, other | Ref. | Ref. | |||
| Type of Medicare plan | |||||
| HMO | 0.25 | 0.12 | 0.035 | 0.67 (0.49–0.92) | 0.014 |
| PPO, other | 0.31 | 0.13 | 0.022 | 0.78 (0.57–1.06) | 0.109 |
| PFFS | Ref. | Ref. | |||
| Clinical characteristics | |||||
| Any hypoglycemia | |||||
| Yes | 0.13 | 0.12 | 0.281 | 2.08 (1.55–2.78) | <.0001 |
| No | Ref. | Ref. | |||
| aDCSI score | |||||
| 0–1 | −0.26 | 0.12 | 0.029 | 0.58 (0.39–0.87) | 0.008 |
| 2 | −0.09 | 0.12 | 0.456 | 0.86 (0.59–1.25) | 0.429 |
| 3–4 | −0.04 | 0.10 | 0.708 | 0.82 (0.61–1.11) | 0.202 |
| 5–12 | Ref. | Ref. | |||
| A1C | |||||
| <8.0% | Ref. | Ref. | |||
| 8.0–9.0% | −0.46 | 0.10 | <0.001 | 1.60 (0.96–2.68) | 0.073 |
| >9.0% | −1.57 | 0.09 | <0.001 | 1.66 (1.04–2.65) | 0.034 |
| Healthcare utilization | |||||
| Any inpatient visit | |||||
| Yes | −0.15 | 0.11 | 0.181 | 1.58 (1.13–2.21) | 0.007 |
| No | Ref. | Ref. | |||
| Any ED visit | |||||
| Yes | −0.17 | 0.10 | 0.108 | 1.56 (1.13–2.14) | 0.007 |
| No | Ref. | Ref. | |||
| Number of OADs | |||||
| 1 | 0.07 | 0.10 | 0.495 | 0.97 (0.73–1.29) | 0.814 |
| 2 | 0.19 | 0.10 | 0.053 | 1.00 (0.73–1.37) | 0.999 |
| ≥3 | 0.40 | 0.16 | 0.012 | 0.79 (0.44–1.42) | 0.433 |
| No OADs | Ref. | Ref. | |||
| Complexities specific to older patients | |||||
| Cognitive impairment | |||||
| Yes | 0.18 | 0.15 | 0.221 | 1.95 (1.43–2.65) | <.0001 |
| No | Ref. | Ref. | |||
| Major depression | |||||
| Yes | 0.17 | 0.13 | 0.216 | 1.06 (0.76–1.48) | 0.737 |
| No | Ref. | Ref. | |||
| Polypharmacy (>13 drugs) | |||||
| Yes | 0.02 | 0.13 | 0.871 | 1.21 (0.88–1.66) | 0.250 |
| No | Ref. | Ref. | |||
| Falls and falls risk† | |||||
| Yes | NA | 1.42 (0.90–2.25) | 0.130 | ||
| No | Ref. | ||||
| Urinary incontinence† | |||||
| Yes | NA | 0.86 (0.51–1.47) | 0.592 | ||
| No | Ref. | ||||
aDCSI, adapted Diabetes Complications Severity Index; CI, confidence interval; ED, emergency department; HMO, health maintenance organization; NA, Not Applicable; OAD, oral antidiabetes drug; OR, odds ratio; PFFS, private fee-for-service; PPO, preferred provider organization; RAI, rapid-acting insulin; ref., reference; SE, standard error; T2D, type 2 diabetes.
*
Based on 3,927 elderly Medicare beneficiaries who had two or more claims for RAI during the 12-month follow-up period.
†
Not included in the logistic regression model for change in A1C.