The association between continuity of care and the severity of diabetes-related complications

Abstract

Purpose: To assess the association between continuity of care and severity of diabetes-related complications for geriatric diabetic patients.Methods: A retrospective study using 2009-2013 Taiwan’s National Health Insurance Research Database one million beneficiary version were conducted. Utilization data of 3,885 geriatric patients who newly had type 2 diabetes were studied. Five-year Continuity of Care Index (COCI) and the adapted Diabetes Complications Severity Index (aDCSI) of each subject were calculated. A Group-based trajectory modeling (GBTM) was used to distinguish patients with similar five-year COCI into different trajectories.  A general estimating equation(GEE) was used to assess the association between COCI trajectories and aDCSI. Results: The ratio of male to female in this study was 2:3. At the time of inclusion, the average age was 71.79 (4.65) years old. GBTM subjects can be divided into four different trajectories according to their COCI: low-level continuity of care trajectories, increasing continuity of care trajectories, decreasing continuity of care trajectory, and high-level continuity of care trajectory. After GEE analysis,  the high continuity of care trajectories were associated with a significant decrease in aDCSI score.Conclusion:The results of this study suggested better continuity of care was associated with less severity of diabetes-related complications for geriatric patients.