title: Optimal management of diabetes among overweight and obese adults.
abstract: OBJECTIVE
  To explore potential weight-related disparities in the quality of care for adults with diabetes in a large managed care health plan according to recommended quality indicators.
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  A total of 164,721 Kaiser Permanente Southern California members aged 18 to 75 years with diabetes who had 1 or more health encounters with a weight and height measurement between July 1, 2007, and June 30, 2008, were identified. The 9 Healthcare Effectiveness Data and Information Set (HEDIS) quality-of-care measures were examined: 4 screening measures (glycated hemoglobin [A1C], retinal examination, lipids, and nephropathy) and 5 control measures (2 for A1C, 2 for blood pressure, and 1 for low-density lipoprotein cholesterol [LDLC]), using data extracted from electronic health records (EHRs). Weight and height from the EHR were used to calculate body mass index (BMI). Adjusted odds ratios and 95% confidence intervals were calculated to examine the association between BMI categories and HEDIS quality-of-care measures.
  
  
  RESULTS
  Among individuals with diabetes, 12% were in the healthy-weight category, 30% were overweight, and 28%, 17%, and 14% were in obese categories I, II, and III, respectively. Overweight and obese individuals were more likely than their healthy-weight counterparts to have screening measures performed. However, among those tested or screened, overweight and obese individuals were less likely to have their A1C and blood pressure controlled. LDL-C control increased as BMI increased.
  
  
  CONCLUSIONS
  These findings highlight the need for interventions to improve glycemic and blood pressure control among overweight and obese patients with diabetes.
authors.forename: Denison S
authors.initials: DS
authors.lastname: Ryan
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Coleman
authors.forename: Jean M
authors.initials: JM
authors.lastname: Lawrence
authors.forename: Teresa N
authors.initials: TN
authors.lastname: Harrison
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D003430:Cross-Sectional Studies; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D019984:Quality Indicators, Health Care