Outcomes of Medicare-covered diabetes self-management training for cancer survivors with diabetes

Wei-Chen Lee; Biai Dominique Elmir Digbeu; Hanaa S Sallam; Hani Serag; Yong-Fang Kuo

doi:10.1007/s11764-023-01487-x

Outcomes of Medicare-covered diabetes self-management training for cancer survivors with diabetes

J Cancer Surviv. 2023 Nov 24. doi: 10.1007/s11764-023-01487-x. Online ahead of print.

Authors

Wei-Chen Lee¹, Biai Dominique Elmir Digbeu², Hanaa S Sallam², Hani Serag², Yong-Fang Kuo²

Affiliations

¹ The University of Texas Medical Branch at Galveston, Galveston, USA. weilee@utmb.edu.
² The University of Texas Medical Branch at Galveston, Galveston, USA.

PMID: 37999856
DOI: 10.1007/s11764-023-01487-x

Abstract

Purpose: This study aimed to examine the impact of utilization of the Medicare-covered Diabetes Self-Management Training (DSMT) on the likelihood of receiving preventive care and on outcomes among cancer survivors with diabetes.

Methods: We conducted a retrospective cohort study using 1999-2019 Texas Cancer Registry-Medicare linkage data for beneficiaries diagnosed with prostate, colorectal, or breast cancer for ≥5 years. We used propensity score matching to estimate the beneficiaries' probability of receiving DSMT and matched it with non-users. The observed DSMT outcomes were hospitalization, ER visit, eye exam, HbA1c test, foot exam, nephropathy, and all-cause mortality. DSMT utilization was set at attending 1, 2, and 3 or more sessions. Conditional Cox proportional hazard regression was built to determine the association between DSMT use and each respective outcome, unadjusted and adjusted for patients' covariates.

Results: A total of 79,271 beneficiaries (65% had diabetes-related complications, and 41% were either prostate or breast cancer survivors) were included. We found that (1) DSMT users had more eye exams (HR=1.27), HbA1c tests (HR=1.47), foot exams (HR=1.21), and nephropathy visits (HR=1.11), and less hospitalization (HR=0.86) and overall mortality (HR=0.70) (p≤0.01 each vs. non-users); (2) among DSMT users, 56% attended one session, 24% attended 2 sessions, and 20% attended 3 or more sessions; (3) attending 2 or ≥3 DSMT sessions was associated with more eye exams (HR=1.14), HbA1c tests (HR=1.12), and foot exams (HR=1.24).

Conclusions: DSMT is instrumental to preventing or delaying complications of diabetes in cancer survivors and reducing their overall mortality. The findings may inform future efforts to promote the value of DSMT for cancer survivors.

Implications for cancer survivors: Medicare-covered DSMT offers a great value to cancer survivors with diabetes.

Keywords: Cancer survivor; Diabetes; Medicare.

Abstract

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