Type 2 Diabetes Mellitus
Conditions
Brief summary
This study investigates whether an intensive lifestyle intervention for type 2 diabetes had long-term effects on Medicare enrollment, health care use, and health care spending.
Detailed description
The Look AHEAD study tested whether participants with type 2 diabetes assigned to an intensive lifestyle intervention (ILI) for weight loss exhibited reductions in cardiovascular morbidity and mortality, relative to a control group receiving usual care and diabetes support and education. During the 12-year intervention period, the ILI led to persistent reductions in weight, waist circumference, and hemoglobin A1c and improvements in physical fitness. In addition, the ILI led to reductions in hospitalizations, hospital days, and prescription drug spending during the intervention period (through 2012). However, the longer-term effects (2012 and later) on health care use and spending remain unknown. In an ongoing ancillary study, the researchers are investigating the effects of the ILI on economic outcomes, during and after the study. As a part of this study, the study team is linking consenting Look AHEAD participants to Medicare databases. The researchers will investigate the long-term effects of ILI on health care use and health care spending. By 2012 nearly all Look AHEAD participants were eligible for Medicare due to age (over 65). To the extent that Look AHEAD participants developed severe disabilities, the participants may have gained Medicare eligibility earlier through enrollment in Social Security Disability Insurance (SSDI). Thus, the researchers will also test for differences in the Medicare enrollment channel between ILI and control group participants, specifically whether the groups enrolled through SSDI at different rates.
Interventions
BEHAVIORALIntensive lifestyle intervention
Lifestyle intervention focused on weight loss through diet and physical activity
BEHAVIORALDiabetes support and education
Behavioral intervention focused on diabetes support and education
Sponsors
University of Southern California
Wake Forest University
University of Minnesota
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
45 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Look AHEAD participation: met age requirements and other criteria at time of study enrollment (as noted in Look AHEAD Research Group (2013)) * Consented to administrative data linkages * Provided individual identifiers that could be linked with Medicare databases * Were successfully linked to Medicare data
Exclusion criteria
\-
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total inpatient (general hospital/acute care) discharges | 12-years | This is based on patient-level HEDIS specifications. |
| Medicare Part D Prescription Drug Fill Count | 12-years | Derived measure indicating number of 30-day supply equivalents in each year. |
| Total number of emergency department visits | 12-years | This is based on patient-level HEDIS specifications. |
| Total inpatient (general hospital/acute care) days | 12-years | This is based on patient-level HEDIS specifications. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total Medicare spending | 12-years | Sums Medicare payments across service use categories |
| Medicare inpatient payments | 12-years | Patient-level inpatient payments |
| Medicare Part D drug payments | 12-years | Part D plan payments for covered drugs in a given year |
| Medicare Part D drug costs | 12-years | Gross drug costs for all Part D drugs for a given year |
| Medicare outpatient visits | 12-years | Based on patient-level HEDIS specifications |
| Medicare hospital outpatient payments | 12-years | Based on Medicare records |
| Medicare Part B physician payments | 12-years | Based on Medicare records |
| Medicare Skilled Nursing Facility payments | 12-years | Based on Medicare records |
Other
| Measure | Time frame | Description |
|---|---|---|
| Hospital readmissions | 12-years | Based on HEDIS specifications |
| Originally eligible for Medicare due to End Stage Renal Disease (ESRD) | 12-years | This is based on Original Reason for Entitlement field in Medicare Beneficiary Summary File |
| Originally eligible for Medicare through Disability Insurance Benefits | 12-years | This is based on Original Reason for Entitlement field in Medicare Beneficiary Summary File |
| Inpatient medicine discharges | 12-years | Based on patient-level HEDIS specifications |
| Inpatient surgical discharges | 12-years | Based on patient-level HEDIS specifications |
| Inpatient medicine days | 12-years | Based on patient-level HEDIS specifications |
| Inpatient surgical days | 12-years | Based on patient-level HEDIS specifications |
| Medicare Dialysis Payments | 12-years | Based on Medicare records |
| Medicare Durable Medical Equipment payments | 12-years | Based on Medicare records |
| Medicare Imaging + Test payments | 12-years | Based on Medicare records |
| Originally eligible for Medicare through Old Age and Survivor's Insurance | 12-years | This is based on Original Reason for Entitlement field in Medicare Beneficiary Summary File |
Outcome results
None listed