Patient characteristics predicting failure to receive indicated care for type 2 diabetes

Aims: Diabetes complications are potentially avoidable, yet incomplete care is common. Little is known about patient characteristics that predict incomplete care. Methods: English Longitudinal Study of Ageing participants aged 50 years or older with diabetes reported on four diabetes quality indicators (QIs) in 2008-9 and 2010-11. Annual checks for glycated haemoglobin (HbA1c), proteinuria and foot examination were assessed as a care bundle (n=907). A further QI assessed whether participants with cardiac risk factors were offered ACE inhibitors/receptor blockers (n=759). Individual’s baseline (2008-9) socio-demographic, lifestyle and health characteristics, diabetes self-management knowledge and health literacy, and previous QI achievement were assessed with logistic regressions on outcomes in 2010-11. Results: A third of participants (2008-9=32.8%; 2010-11=32.2%) did not receive all annual checks in the care bundle. Nearly half of those eligible were not offered ACE inhibitors/receptor blockers (2008- 9=44.6%; 2010-11=44.5%). Odds of not receiving a complete care bundle were increased for participants lacking diabetes self-management knowledge (OR=2.05), having poorer cognitive performance (OR=1.78) or having previously received incomplete care (OR=3.32). Participants who were single (OR=2.16), had with low health literacy (OR=1.50) and who had received incomplete care previously (OR=6.94) were less likely to subsequently be offered ACE inhibitors/receptor blockers, whereas trend test showed that being older (OR=0.76) and increased BMI categorisation (OR=0.70) improved odds of receiving this aspect of care. Conclusions: Quality improvement initiatives for diabetes might usefully target patients with characteristics shown here to predict non-receipt of indicated care, such as poor knowledge of annual diabetes care processes or previous receipt of incomplete care.