Title
Utilization of diabetes self-management program among breast, prostate, and colorectal cancer survivors: Using 2006–2019Texas Medicare data
Authors
Wei-Chen Lee1, Biai Dominique Elmir Digbeu 2, Hani Serag3, Hanaa Sallam3, Yong-Fang Kuo 2
Journal
PLOS ONE
Abstract
Background: Cancer treatment is associated with inferior health outcomes such as diabetes. Medicare provides Diabetes Self-Management Training (DSMT) program to beneficiaries to achieve normal metabolic control and reduce the risk of
micro and macro-vascular complications. This study aimed to examine the trend of DSMT utilization among cancer survivors and assess individual characteristics associated with it.
Methods: The data for this study was from Texas Cancer Registry-Medicare linkage data of patients with prostate, breast, or colorectal cancer diagnosed in 1999-2017. Outcome variables include the number of first-time DSMT users, the number
of total users, and the average number of DSMT utilization in minutes. We performed logistic regression and gamma regression to obtain a multivariable-adjusted odds ratio for the association between DSMT utilization and individual characteristics.
Results: The number of first-time users has slowly increased over the years (from 99 to 769 per 1,000) but suddenly dropped after 2016. The number of all users (first-time and follow-up users) has increased (from 123 to 1,201 per 1,000)
and plateaued after 2016. Determinants including Hispanic ethnicity (O.R. = 1.10) and Medicare-Medicaid dual eligibility (O.R. = 1.25) are positively associated with both the initiation and retention of the DSMT. A barrier to both initiation and retention
of DSMT is living in a metropolitan area (O.R. = 0.90).
Conclusions: Multi-level strategies to enhance accessibility and availability of DSMT programs for Medicare beneficiaries are highly recommended. Examining the determinants of initiation and retention of DSMT over 14 years provides insights
on strategies to meet the needs of cancer survivors and reduce the burden of diabetes on them.