title: Receipt of monitoring of diabetes mellitus in older adults with comorbid dementia.
abstract: OBJECTIVE
  To examine the extent to which receipt of recommended monitoring of diabetes mellitus (DM) differed for participants with and without comorbid dementia, as well as the effect of other comorbidities on monitoring of DM in individuals with comorbid dementia.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Secondary analysis of 2005/2006 claims and enrollment data for a 5% national random sample of Medicare beneficiaries.
  
  
  METHODS
  Two hundred eighty-eight thousand eight hundred five Medicare fee-for-service beneficiaries with a diagnosis of DM before 2006, 44,717 (16%) of whom had evidence of comorbid dementia in claims.
  
  
  METHODS
  Established algorithms were used to determine whether patients received at least one glycosylated hemoglobin (HbA1c) test, one low-density lipoprotein cholesterol (LDL-C) test, and one annual eye examination in 2006 and to construct variables representing comorbidities common in DM, sociodemographic characteristics, and patterns of healthcare utilization.
  
  
  RESULTS
  In unadjusted and fully adjusted models, the presence of dementia reduced the likelihood of receiving HbA1c tests, LDL-C tests, and eye examinations, with effects being smallest for HbA1c tests. The effects of other comorbidities on DM monitoring in participants with dementia varied according to the nature of the comorbidity and the specific test.
  
  
  CONCLUSIONS
  Dementia reduces the likelihood that individuals with DM will receive recommended annual monitoring for DM. More research is needed to understand reasons for lower monitoring in this subgroup and how this affects functioning, adverse events, and quality of life.
authors.affiliation: Health Services Research and Development, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15261, USA. ctthorpe@pitt.edu
authors.forename: Carolyn T
authors.initials: CT
authors.lastname: Thorpe
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Thorpe
authors.forename: Amy J H
authors.initials: AJ
authors.lastname: Kind
authors.forename: Christie M
authors.initials: CM
authors.lastname: Bartels
authors.forename: Christine M
authors.initials: CM
authors.lastname: Everett
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003704:Dementia / Q000150:complications / Q000191:economics*; D003920:Diabetes Mellitus / Q000191:economics*; D003954:Diagnostic Services / Q000191:economics / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014481:United States
chemical_list: D006442:Glycated Hemoglobin