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Consistency of Hemoglobin A1c Testing and Cardiovascular Outcomes in Medicare Patients With Diabetes

View Article: PubMed Central - PubMed

ABSTRACT

Background: Annual hemoglobin A1c testing is recommended for patients with diabetes mellitus. However, it is unknown how consistently patients with diabetes mellitus receive hemoglobin A1c testing over time, or whether testing consistency is associated with adverse cardiovascular outcomes.

Methods and results: We identified 1 574 415 Medicare patients (2002–2012) with diabetes mellitus over the age of 65. We followed each patient for a minimum of 3 years to determine their consistency in hemoglobin A1C testing, using 3 categories: low (testing in 0 or 1 of 3 years), medium (testing in 2 of 3 years), and high (testing in all 3 years). In unweighted and inverse propensity‐weighted cohorts, we examined associations between testing consistency and major adverse cardiovascular events, defined as death, myocardial infarction, stroke, amputation, or the need for leg revascularization. Overall, 70.2% of patients received high‐consistency testing, 17.6% of patients received medium‐consistency testing, and 12.2% of patients received low‐consistency testing. When compared to high‐consistency testing, low‐consistency testing was associated with a higher risk of adverse cardiovascular events or death in unweighted analyses (hazard ratio [HR]=1.21; 95% CI, 1.20–1.23; P<0.001), inverse propensity‐weighted analyses (HR=1.16; 95% CI, 1.15–1.17; P<0.001), and weighted analyses limited to patients who had at least 4 physician visits annually (HR=1.15; 95% CI, 1.15–1.16; P<0.001). Less‐consistent testing was associated with worse results for each cardiovascular outcome and in analyses using all years as the exposure.

Conclusions: Consistent annual hemoglobin A1c testing is associated with fewer adverse cardiovascular outcomes in this observational cohort of Medicare patients of diabetes mellitus.

No MeSH data available.


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A, Freedom from major adverse cardiac events, by testing consistency category. B, Freedom from death, by testing consistency category. C, Freedom from myocardial infarction, by testing consistency category. D, Freedom from stroke, by testing consistency category. E, Freedom from leg vascular procedure, by testing consistency category. F, Freedom from amputation, by testing consistency category.
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jah31665-fig-0001: A, Freedom from major adverse cardiac events, by testing consistency category. B, Freedom from death, by testing consistency category. C, Freedom from myocardial infarction, by testing consistency category. D, Freedom from stroke, by testing consistency category. E, Freedom from leg vascular procedure, by testing consistency category. F, Freedom from amputation, by testing consistency category.

Mentions: In unweighted analyses, we found 62.3% of patients treated with low‐consistency testing experienced death or a major adverse cardiovascular event within 7 years of follow‐up (Figure A). The rate of death or an adverse cardiovascular event was 13.2% lower, in absolute terms, for patients treated with high‐consistency testing (49.0%), a difference that was highly significant across testing consistency categories (log rank, P<0.001). Similar trends were observed for all individual components of our adverse cardiovascular outcomes, including death, myocardial infarction, stroke, lower‐extremity vascular procedures, and leg amputation (FigureB througF). We calculated unweighted hazard ratios, with surrounding 95% CIs, for each outcome, across consistency categories. These demonstrated an inverse relationship between testing consistency and the risk of death or a major adverse cardiovascular event, as well as each of its individual components (Table 2).


Consistency of Hemoglobin A1c Testing and Cardiovascular Outcomes in Medicare Patients With Diabetes
A, Freedom from major adverse cardiac events, by testing consistency category. B, Freedom from death, by testing consistency category. C, Freedom from myocardial infarction, by testing consistency category. D, Freedom from stroke, by testing consistency category. E, Freedom from leg vascular procedure, by testing consistency category. F, Freedom from amputation, by testing consistency category.
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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5015285&req=5

jah31665-fig-0001: A, Freedom from major adverse cardiac events, by testing consistency category. B, Freedom from death, by testing consistency category. C, Freedom from myocardial infarction, by testing consistency category. D, Freedom from stroke, by testing consistency category. E, Freedom from leg vascular procedure, by testing consistency category. F, Freedom from amputation, by testing consistency category.
Mentions: In unweighted analyses, we found 62.3% of patients treated with low‐consistency testing experienced death or a major adverse cardiovascular event within 7 years of follow‐up (Figure A). The rate of death or an adverse cardiovascular event was 13.2% lower, in absolute terms, for patients treated with high‐consistency testing (49.0%), a difference that was highly significant across testing consistency categories (log rank, P<0.001). Similar trends were observed for all individual components of our adverse cardiovascular outcomes, including death, myocardial infarction, stroke, lower‐extremity vascular procedures, and leg amputation (FigureB througF). We calculated unweighted hazard ratios, with surrounding 95% CIs, for each outcome, across consistency categories. These demonstrated an inverse relationship between testing consistency and the risk of death or a major adverse cardiovascular event, as well as each of its individual components (Table 2).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Annual hemoglobin A1c testing is recommended for patients with diabetes mellitus. However, it is unknown how consistently patients with diabetes mellitus receive hemoglobin A1c testing over time, or whether testing consistency is associated with adverse cardiovascular outcomes.

Methods and results: We identified 1&nbsp;574&nbsp;415 Medicare patients (2002&ndash;2012) with diabetes mellitus over the age of 65. We followed each patient for a minimum of 3&nbsp;years to determine their consistency in hemoglobin A1C testing, using 3 categories: low (testing in 0 or 1 of 3&nbsp;years), medium (testing in 2 of 3&nbsp;years), and high (testing in all 3&nbsp;years). In unweighted and inverse propensity&#8208;weighted cohorts, we examined associations between testing consistency and major adverse cardiovascular events, defined as death, myocardial infarction, stroke, amputation, or the need for leg revascularization. Overall, 70.2% of patients received high&#8208;consistency testing, 17.6% of patients received medium&#8208;consistency testing, and 12.2% of patients received low&#8208;consistency testing. When compared to high&#8208;consistency testing, low&#8208;consistency testing was associated with a higher risk of adverse cardiovascular events or death in unweighted analyses (hazard ratio [HR]=1.21; 95% CI, 1.20&ndash;1.23; P&lt;0.001), inverse propensity&#8208;weighted analyses (HR=1.16; 95% CI, 1.15&ndash;1.17; P&lt;0.001), and weighted analyses limited to patients who had at least 4 physician visits annually (HR=1.15; 95% CI, 1.15&ndash;1.16; P&lt;0.001). Less&#8208;consistent testing was associated with worse results for each cardiovascular outcome and in analyses using all years as the exposure.

Conclusions: Consistent annual hemoglobin A1c testing is associated with fewer adverse cardiovascular outcomes in this observational cohort of Medicare patients of diabetes mellitus.

No MeSH data available.


Related in: MedlinePlus