REAL-WORLD HEALTHCARE UTILIZATION AND CLINICAL CHARACTERISTICS ACROSS DIABETES COMPLICATIONS SEVERITY IN MEDICARE ADVANTAGE INSURED ADULTS WITH TYPE 2 DIABETES
Author(s)
Yi Liu, PhD1, Laura Lupton, MHA, MD2, Xiaowu Sun, PhD1;
1CVS Health, Woonsocket, RI, USA, 2CVS Health, Wellesley, MA, USA
1CVS Health, Woonsocket, RI, USA, 2CVS Health, Wellesley, MA, USA
OBJECTIVES: Type 2 diabetes (T2DM) is associated with substantial clinical complexity and healthcare utilization. The adapted Diabetes Complication Severity Index (aDCSI) provides a claims-based measure of complication burden, yet limited evidence characterizes how demographic factors and healthcare resource utilization (HCRU) vary across aDCSI levels.
METHODS: This retrospective cohort study used 2024 claims from national payer Medicare Advantage population to identify adults with T2DM with ≥12 months of continuous enrollment. aDCSI scores (range 0-13) were calculated using validated ICD10CM definitions and analyzed as continuous values and categorical groups (0, 1, 2, 3, 4, 5+). Social Vulnerability Index (SVI) was linked by residential ZIP code and stratified into quartiles. HCRU included per patient counts of endocrinology, primary care, other specialist, emergency department, and inpatient encounters. Descriptive statistics compared characteristics across aDCSI groups.
RESULTS: Among 747,247 adults with T2DM, 51.7% were female, and 48.3% were male. The mean age was 73.1 years (median 70; SD 8.6), and mean aDCSI was 2.74 (SD 2.06; median 2). Higher aDCSI levels were associated with older age and greater social vulnerability; individuals aged >75 accounted for 51.3% of the aDCSI ≥5 group. HCRU increased consistently with higher aDCSI. Mean endocrinology visits rose from 0.2 (SD 0.8) to 0.5 (SD 1.3), PCP visits from 4.3 (SD 4.0) to 8.4 (SD 7.0), and other specialist visits from 5.5 (SD 5.7) to 12.1 (SD 10.0) across the lowest to highest aDCSI groups. ER visits increased from 0.3 (SD 0.9) to 1.0 (SD 1.9), and inpatient admissions from 0.0 (SD 0.2) to 0.8 (SD 1.3).
CONCLUSIONS: Greater diabetes complication severity, as measured by aDCSI, was associated with higher SVI and increased HCRU across outpatient, emergency, and inpatient settings. These findings support the use of aDCSI as a practical tool for identifying high need T2DM populations and informing population health management and real-world economic evaluations.
METHODS: This retrospective cohort study used 2024 claims from national payer Medicare Advantage population to identify adults with T2DM with ≥12 months of continuous enrollment. aDCSI scores (range 0-13) were calculated using validated ICD10CM definitions and analyzed as continuous values and categorical groups (0, 1, 2, 3, 4, 5+). Social Vulnerability Index (SVI) was linked by residential ZIP code and stratified into quartiles. HCRU included per patient counts of endocrinology, primary care, other specialist, emergency department, and inpatient encounters. Descriptive statistics compared characteristics across aDCSI groups.
RESULTS: Among 747,247 adults with T2DM, 51.7% were female, and 48.3% were male. The mean age was 73.1 years (median 70; SD 8.6), and mean aDCSI was 2.74 (SD 2.06; median 2). Higher aDCSI levels were associated with older age and greater social vulnerability; individuals aged >75 accounted for 51.3% of the aDCSI ≥5 group. HCRU increased consistently with higher aDCSI. Mean endocrinology visits rose from 0.2 (SD 0.8) to 0.5 (SD 1.3), PCP visits from 4.3 (SD 4.0) to 8.4 (SD 7.0), and other specialist visits from 5.5 (SD 5.7) to 12.1 (SD 10.0) across the lowest to highest aDCSI groups. ER visits increased from 0.3 (SD 0.9) to 1.0 (SD 1.9), and inpatient admissions from 0.0 (SD 0.2) to 0.8 (SD 1.3).
CONCLUSIONS: Greater diabetes complication severity, as measured by aDCSI, was associated with higher SVI and increased HCRU across outpatient, emergency, and inpatient settings. These findings support the use of aDCSI as a practical tool for identifying high need T2DM populations and informing population health management and real-world economic evaluations.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD114
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)