Annual wellness visits linked to lower amputation risk in type 2 diabetes

Medicare patients with type 2 diabetes who participate in annual wellness screenings were 36% less likely to require lower limb amputations, according to the results of a recent study.

A decade-long analysis of data from Medicare patients in the ‘diabetes belt’, study results indicate that patients who attended an annual wellness visit were 36% less likely of requiring major lower extremity amputation in the same year as those who did not in analyzes adjusted for demographic factors, comorbidities, and major risk factors, including diabetic foot ulcers , neuropathy, peripheral vascular disease and access to care factors. Additional information from the study included an increased likelihood of requiring major lower extremity amputation in the “diabetes belt”, which encompasses 644 counties in the Appalachian and southeastern regions of the United States, was 27% higher than that of the surrounding regions.

“Our results supported our hypothesis that annual wellness visits are associated with a reduced risk of major lower extremity amputations, underscoring the importance of connecting patients to preventive care services,” said Jennifer Lobo, PhD, researcher in the Department of Public Health Sciences at AVU. .

Citing previous research suggesting that patients in the “diabetes belt” region of the United States had a higher rate of lower extremity amputations than surrounding areas, Lobo and colleagues at the UVA Department of Health Sciences sought to assess factors associated with an increased or reduced likelihood of amputations among patients in the region. To do this, the investigators designed their study as an analysis of data from Medicare Fee-for-Service beneficiaries with type 2 diabetes in the region from 2006 to 2015. For the purposes of the current analysis, the investigators sought to assess how participation in annual wellness visits might influence risk of major lower extremity with adjustment for demographic factors, major comorbidities and risk factors, and access to care factors.

Investigators identified 1,034,525 diabetes patients from the Diabetes Belt region and 1,018,583 diabetes patients from surrounding counties to include in their analyses. Patients in the diabetes belt region had a mean age of 75.5 (SE, 0.01) years, 44.3% were male, and 22.7% were non-Hispanic black patients. Surrounding area patients had a mean age of 76.2 (SE, 0.01) years, 45.8% were male, and 15.0% were non-Hispanic black patients.

After analysis, investigators found that the risks of major lower limb amputations were 36% lower in patients who used annual wellness visits in the same year compared to those who did not in adjusted analyses. Additionally, the results suggest that patients in the Diabetes Belt region were about 27% more likely to need major lower limb amputation than those with diabetes in surrounding counties.

“While annual wellness visits are a free visit for qualified Medicare beneficiaries, additional incentives or resources to overcome systemic barriers to accessing care are needed to support patient attendance,” said Lobo. “Patient education about the value of annual wellness visits and preventive care could also help improve the use of annual wellness visits, hopefully reducing the rate of major amputations.”

This study, “Association Between Annual Wellness Visits and Major Amputations Among Medicare Beneficiaries in the Diabetes Belt,” was presented at the 2022 Scientific Sessions of the American Diabetes Association.

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