Impact of opioid analgesic use on diabetes quality of care and outcomes: A longitudinal population-based study
BACKGROUND: Opioid analgesics are associated with serious adverse effects that have the potential to adversely affect diabetes management. OBJECTIVE: To examine the association of opioid dose with selected diabetes performance and outcomes measures. METHODS: A longitudinal retrospective study was conducted among people with diabetes who received Schedule II /III opioids through Blue Cross Blue Shield of Texas (BCBSTX) in 2008-2012. Clinical and pharmacologic therapy was analyzed in 6-month intervals for study subjects. After the first opioid prescription, the morphine equivalent daily dose (MEDD) of opioid in a 6-month interval was broken down into 0 mg, 1-19 mg, 20-49 mg, 50-99 mg, and 100 mg or more categories as used in other studies. Using fixed effects estimation and controlling for various comorbidities and other utilization measures, the association of opioid dose was examined in relation to quality of care and outcomes measures within each six month interval including: receipt of a hemoglobin A1C (HbA1c) test, receipt of a low density lipoprotein (LDL) test, any hospitalization, diabetes-related potentially preventable hospitalization, any emergency department visit, and emergency department visit for uncontrolled diabetes. In addition, associations were examined in relation to healthcare costs. RESULTS: Of the 329,249 individuals with diagnosed diabetes, 29,033 were selected for the study after applying all inclusion/exclusion criteria. Persons receiving 100 mg or more MEDD of opioids were 19% and 16% less likely to receive HbA1c and LDL testing, respectively, than those on no opioids. A dose response association appeared between opioid dose and diabetes outcomes. Compared to those on no opioids, persons prescribed 100 mg or more MEDD of opioids had adjusted odds ratios of 6.22 (95% CI 4.94, 7.83) for any hospitalization, 2.16 (95% CI 1.34, 3.48) for diabetes-related potentially preventable hospitalization, 3.83 (95% CI 3.20, 4.58) for any emergency department visit, and 2.11 (95% CI 1.07, 4.17) for emergency department visit for uncontrolled diabetes. Healthcare costs increased monotonically with increasing MEDD. Compared to those intervals with no opioids, healthcare costs were 49%, 68%, 96%, and 119% higher for 1-19 mg MEDD, 20-49 mg MEDD, 50-99 mg MEDD, and 100 mg or more MEDD of opioids, respectively. CONCLUSIONS: Patients who received opioids prescription at higher doses appeared to have poorer diabetes quality of care and outcomes in diabetes and incurred higher costs compared to those not receiving opioids. The findings suggest that clinicians, payers, and policymakers should be attentive to deficiencies in care and high expenditures for persons with diabetes who are treated with high dose opioid therapy.
Public health|Health care management
Gautam, Santosh, "Impact of opioid analgesic use on diabetes quality of care and outcomes: A longitudinal population-based study" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3665085.