Adherence to American Diabetes Association and Centers for Medicare & Medicaid Services Guidelines for Diabetes Management in Puerto Rico’s Medicaid Population

Abstract

Objective: This retrospective analysis aimed to assess compliance with the diabetes mellitus (DM) treatment guidelines published by the American Diabetes Association and the Centers for Medicare and Medicaid Services (United States) among Puerto Rican patients enrolled in Medicaid. Methods: In this retrospective analysis of 2019 encounter data, we identified 128,065 patients with a diagnosis of type 1 or type 2 DM. The initial population of patients was assessed based on criteria including sex, age, insurance provider, type of medical provider (primary care or specialist), type of procedures and medical complications. Results: Of the 128, 065 detected patients, only 44.4% had been seen by a primary care provider. Among all these patients, 4,346 (3.4%) were aged 0–18 years and had type 2 DM. Only 4.1% of the patients had been evaluated by an endocrinologist, and 1.3% by a nephrologist. Moreover, only 48% of the patients had an A1C test performed at least once in 2019; 26% had had a test for microalbumin determination; and 44% had undergone an estimated glomerular filtration rate assessment (as part of a comprehensive metabolic panel). Tests for the early detection of eye and kidney complications were very infrequently conducted. Individual health insurers showed similar levels of (low) compliance with the national recommendations for DM management. Conclusion: Limited patient and physician engagement are 2 primary factors contributing to poor adherence to national diabetes care guidelines among Medicaid patients in Puerto Rico. This lack of adherence can lead to an increase in patient mortality (diabetes is the third highest cause of mortality in Puerto Rico) and morbidity from both macro- and microvascular complications.