Prevalence and Correlates of Prolonged Lapses in Physician Care Among Adults with Diabetes over 4 Years: A National Study, 2018-2022.

BACKGROUND

Optimal management of diabetes necessitates regular, longitudinal care from a dedicated provider. It is unknown how many US adults with diabetes experience prolonged lapses in physician care.

OBJECTIVE

To examine the prevalence and correlates of prolonged lapses in physician visits among US adults with diabetes in a nationally representative sample surveyed over a 4-year period, including COVID-pandemic years.

DESIGN

Cross-sectional.

PARTICIPANTS

A total of 1228 adults with diabetes in Medical Expenditure Panel Survey (MEPS) 4-year longitudinal datasets, surveyed 2018-2022.

MAIN MEASURES: Share of diabetic adults experiencing prolonged lapses in physician visits, defined as 1+ calendar year with zero visits to a "diabetes provider" (visits to primary care physicians or endocrinologists) over 4 years. Correlates of inadequate visits, including demographic characteristics, health coverage, and continuity in drug treatment of diabetes, hypertension, and hyperlipidemia after multivariable adjustment.

KEY

RESULTS

MEPS' adult participants with diabetes were predominantly midlife or elderly and had significant rates of comorbid chronic disease and diabetic complications. 49.8% [95% CI 46.0, 53.5] went 1+ year with zero visits to a diabetes provider, and 5.9% [95% CI 4.1, 8.3] had zero visits over a 4-year period. Similar shares with severe diabetes (defined as those with insulin use, or diabetic eye or renal complications) had prolonged lapses; Hispanic, Black, and uninsured individuals had higher rates of inadequate visit frequency. Even after excluding 2020 - when COVID-related care disruptions were most common - 42.9% (95% 39.4, 46.5) of subjects had a 1+ year lapse in care. Prolonged lapses were associated with lapses in medication treatment for diabetes, hypertension, and hyperlipidemia after multivariable adjustment.

CONCLUSIONS

Prolonged lapses in physician visits were common among US adults with diabetes over 2018-2022; such lapses may have adverse clinical effects.