Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

  • 1 Altmetric

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The research was focused on secondary data analysis of 100% Texas Medicare claims with information on patients’ demographics, diagnosis, prescription, procedure, physician’s characteristics, and facility type. The existing data is available from National Cancer Institute (NCI) under the specific data user agreement (DUA). We are not permitted to share these data due to the risk of potential identification of individual patients. To acquire the same type of data, investigators need to submit an application to the NCI.

References

  1. Centers for Disease Prevention and Control. Promoting health for older adults. 2022a. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-older-adults.htm#:~:text=Aging%20increases%20the%20risk%20of,death%2C%20and%20health%20care%20costs. Accessed 2 May 2023.

  2. USAHealthRankings. US Leading Causes. 2023. https://www.worldlifeexpectancy.com/usa-health-rankings. Accessed 2 May 2023.

  3. Centers for Disease Prevention and Control (CDC). Health and economic benefits of diabetes interventions. 2022b. https://www.cdc.gov/chronicdisease/programs-impact/pop/diabetes.htm. Accessed 2 May 2023.

  4. American Diabetes Association (ADA). Economic costs of diabetes in the US in 2017. Diabetes Care. 2018;41(5):917–928

  5. Avalere Health. Comparing detection, treatment, outcomes, and spending for patients with type 2 diabetes between Medicare Advantage and Fee-For-Service Medicare. 2023. https://bettermedicarealliance.org/wp-content/uploads/2023/01/Avalere-Diabetes-Progression-Whitepaper_1.10.23.pdf. Accessed 2 May 2023.

  6. Chen CT, Li L, Brooks G, Hassett M, Schrag D. Medicare spending for breast, prostate, lung, and colorectal cancer patients in the year of diagnosis and year of death. Health Serv Res. 2018;53(4):2118–32. https://doi.org/10.1111/1475-6773.12745.

    Article  PubMed  Google Scholar 

  7. McDaniel CC, Loh FE, Rockwell DM, McDonald CP, Chou C. Economic burden of diabetes among Medicare beneficiaries with cancer. J Pharm Health Serv Res. 2021;12(2):142–51. https://doi.org/10.1093/jphsr/rmab002.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tao H, O’Neil A, Choi Y, Wang W, Wang J, Wang Y, Jia Y, Chen X. Pre- and post-diagnosis diabetes as a risk factor for all-cause and cancer-specific mortality in breast, prostate, and colorectal cancer survivors: a prospective cohort study. Front Endocrinol. 2020;18(11):60. https://doi.org/10.3389/fendo.2020.00060.

    Article  Google Scholar 

  9. Centers for Medicare and Medicaid Services (CMS). Medicare diabetes prevention & diabetes self-management training. 2021. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/DSMT-Fact-Sheet-909381Print-Friendly.pdf. Accessed 2 May 2023.

  10. Wilson-Anumudu F, Quan R, Castro Sweet C, Cerrada C, Juusola J, Turken M, Bradner JC. Early insights from a digitally enhanced diabetes self-management education and support program: single-arm nonrandomized trial. JMIR Diabetes. 2021;6(1):e25295.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Gary TL, Batts-Turner M, Yeh HC, Hill-Briggs F, Bone LR, Wang NY, Levine DM, Powe NR, Saudek CD, Hill MN, McGuire M, Brancati FL. The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med. 2009;169(19):1788–94. https://doi.org/10.1001/archinternmed.2009.338.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gumbs JM. Relationship between diabetes self-management education and self-care behaviors among African American women with type 2 diabetes. J Cult Divers. 2012;19(1):18–22.

    PubMed  Google Scholar 

  13. Johnson TM, Richards J, Churilla JR. Care utilization patterns and diabetes self-management education duration. Diabetes Spectr. 2015;28(3):193–200. https://doi.org/10.2337/diaspect.28.3.193.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nekhlyudov L, O’malley DM, Hudson SV. Integrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities. Lancet Oncol. 2017;18(1):e30–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. World Health Organization. Cancer. 2022. https://www.who.int/news-room/fact-sheets/detail/cancer. Accessed 12 Oct 2023.

  16. Stuart EA. Matching methods for causal inference: a review and a look forward. Stat Sci. 2010;25(1):1–21. https://doi.org/10.1214/09-STS313.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Weymann D, Laskin J, Jones SJM, Lim H, Renouf DJ, Roscoe R, Schrader KA, Sun S, Yip S, Marra MA, Regier DA. Matching methods in precision oncology: an introduction and illustrative example. Mol Genet Genomic Med. 2021;9(1):e1554. https://doi.org/10.1002/mgg3.1554.

    Article  PubMed  Google Scholar 

  18. Medicare Learning Network®. Diabetes Self-Management Training (DSMT) (NCD 40.1). 2023. https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html#DIABETES_SELF. Accessed 2 May 2023.

  19. Shah BR, Hux JE, Laupacis A, Zinman B, Cauch-Dudek K, Booth GL. Administrative data algorithms can describe ambulatory physician utilization. Health Serv Res. 2007;42:1783–96.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. One-year outcomes of diabetes self-management training among Medicare beneficiaries newly diagnosed with diabetes. Med Care. 2017;55(4):391–7. https://doi.org/10.1097/MLR.0000000000000653.

    Article  PubMed  Google Scholar 

  21. Centers for Disease Prevention and Control. Diabetes education linked to better diabetes self-care. 2022c. https://www.cdc.gov/diabetes/resources-publications/research-summaries/DSMES-research-summary.html. Accessed 2 May 2023.

  22. Duncan I, Ahmed T, Li QE, Stetson B, Ruggiero L, Burton K, Rosenthal D, Fitzner K. Assessing the value of the diabetes educator. Diabetes Educ. 2011;37(5):638–57. https://doi.org/10.1177/0145721711416256.

    Article  PubMed  Google Scholar 

  23. Murphy L, Sherifali D, Ali MU, Ibrahim S. Influence of diabetes mellitus on oncological outcomes for patients living with cancer. Sci Diabetes Self Manag Care. 2023;49(2):163–79. https://doi.org/10.1177/26350106231153073.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Rise MB, Pellerud A, Rygg LØ, Steinsbekk A. Making and maintaining lifestyle changes after participating in group-based type 2 diabetes self-management educations: a qualitative study. PLoS ONE. 2013;8(5):e64009.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Essien UR, Tang Y, Figueroa JF, Litam TMA, Tang F, Jones PG, Patel R, Wadhera RK, Desai NR, Mehta SN, Kosiborod MN, Vaduganathan M. Diabetes care among older adults enrolled in Medicare Advantage versus traditional Medicare fee-for-service plans: the Diabetes Collaborative registry. Diabetes Care. 2022;45(7):1549–57. https://doi.org/10.2337/dc21-1178.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Centers for Disease Prevention and Control. Overcoming barriers to referral and treatment. 2021. https://www.cdc.gov/diabetes/dsmes-toolkit/referrals-participation/overcoming-barriers.html#:~:text=Individual%20barriers%20to%20access%20and%20participation%20include%3A&text=Lack%20of%20knowledge%20about%20DSMES%20services,services%2C%20especially%20in%20rural%20areas. Accessed 2 May 2023.

  27. Centers for Disease Control and Prevention. How People with Diabetes Benefit from DSMES. 2023. https://www.cdc.gov/diabetes/dsmes-toolkit/background/benefits.html. Accessed 12 Oct 2023.

Download references

Acknowledgements

The authors would like to acknowledge Christen Walcher, University of Texas Medical Branch Department of Family Medicine, Galveston, TX, for editing the manuscript. Ms. Walcher is a paid employee of the Department of Family Medicine.

The study was made possible by the grant (#RP210130) from Cancer Prevention and Research Institute of Texas (CPRIT) Data Management and Analysis Core (DMAC) and the grant (#HHS0007408000001) from Texas Department of State Health Services (DSHS). The study involving human subjects was reviewed and approved by IRB (#21-0311) of the University of Texas Medical Branch at Galveston and another IRB (#22-0031) for Medicare data overall.

Author information

Authors and Affiliations

  1. The University of Texas Medical Branch at Galveston, Galveston, USA

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

Authors
  1. Wei-Chen Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Biai Dominique Elmir Digbeu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hanaa S. Sallam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hani Serag
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yong-Fang Kuo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Lee, Sallam, Serag, and Kuo were involved in conception, design, and conduct of the study. Digbeu was involved in data management and analysis. Lee and Sallam wrote the first draft of the manuscript and all authors edited, reviewed, and approved the final version of the manuscript. Kuo had full access to all the data in the study.

Corresponding author

Correspondence to Wei-Chen Lee.

Ethics declarations

Competing interests

The authors declare no competing interests.

Conflict of interest

The authors declare no competing interests.

Disclaimer

The funding agency plays no role in the research direction and outcomes.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 39.4 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, WC., Digbeu, B.D.E., Sallam, H.S. et al. Outcomes of Medicare-covered diabetes self-management training for cancer survivors with diabetes. J Cancer Surviv (2023). https://doi.org/10.1007/s11764-023-01487-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11764-023-01487-x

Keywords

Search

Navigation