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Ahmed N, Choe Y, Mustad VA, et al. Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis. BMJ Open Diabetes Res Care. 2018;6(1):e000471doi: 10.1136/bmjdrc-2017-000471.
Ahmed, N., Choe, Y., Mustad, V. A., Chakraborty, S., Goates, S., Luo, M., & Mechanick, J. I. (2018). Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis. BMJ open diabetes research & care, 6(1), e000471. https://doi.org/10.1136/bmjdrc-2017-000471
Ahmed, Naseer, et al. "Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis." BMJ open diabetes research & care vol. 6,1 (2018): e000471. doi: https://doi.org/10.1136/bmjdrc-2017-000471
Ahmed N, Choe Y, Mustad VA, Chakraborty S, Goates S, Luo M, Mechanick JI. Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis. BMJ Open Diabetes Res Care. 2018 Feb 05;6(1):e000471. doi: 10.1136/bmjdrc-2017-000471. eCollection 2018. PMID: 29449950; PMCID: PMC5808633.
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BMJ Open Diabetes Res Care. 2018 Feb 05;6(1):e000471. doi: 10.1136/bmjdrc-2017-000471. eCollection 2018.

Impact of malnutrition on survival and healthcare utilization in Medicare beneficiaries with diabetes: a retrospective cohort analysis.

BMJ open diabetes research & care

Naseer Ahmed, Yong Choe, Vikkie A Mustad, Sumita Chakraborty, Scott Goates, Menghua Luo, Jeffrey I Mechanick

Affiliations

  1. Research and Development, Abbott Nutrition, Columbus, Ohio, USA.
  2. Divisions of Cardiology and Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, Mount Sinai School of Medicine, New York, USA.

PMID: 29449950 PMCID: PMC5808633 DOI: 10.1136/bmjdrc-2017-000471

Abstract

OBJECTIVE: The aim of this study was to examine the impact of pre-existing malnutrition on survival and economic implications in elderly patients with diabetes.

RESEARCH DESIGN AND METHODS: A retrospective observational study was conducted to examine the impact of malnutrition with or without other significant health conditions on survival time and healthcare costs using the Centers for Medicare and Medicaid Services (CMS) data from 1999 to 2014 for beneficiaries with a confirmed first date of initial diagnosis of diabetes (n=15 121 131). The primary outcome was survival time, which was analyzed using all available data and after propensity score matching. Healthcare utilization cost was a secondary outcome.

RESULTS: A total of 801 272 beneficiaries were diagnosed with malnutrition. The analysis on propensity score-matched data for the effect of common conditions on survival showed that the risk for death in beneficiaries with diabetes increased by 69% in malnourished versus normo-nourished (HR, 1.69; 99.9% CI 1.64 to 1.75; P<0.0001) beneficiaries. Malnutrition increased the risk for death within each of the common comorbid conditions including ischemic heart disease (1.63; 1.58 to 1.68), chronic obstructive pulmonary disorder (1.60; 1.55 to 1.65), stroke or transient ischemic attack (1.57; 1.53 to 1.62), heart failure (1.54; 1.50 to 1.59), chronic kidney disease (1.50; 1.46 to 1.55), and acute myocardial infarction (1.47; 1.43 to 1.52). In addition, the annual total spending for the malnourished beneficiaries was significantly greater than that for the normo-nourished beneficiaries ($36 079 vs 20 787; P<0.0001).

CONCLUSIONS: Malnutrition is a significant comorbidity affecting survival and healthcare costs in CMS beneficiaries with diabetes. Evidence-based clinical decision pathways need to be developed and implemented for appropriate screening, assessment, diagnosis and treatment of malnourished patients, and to prevent malnutrition in normo-nourished patients with diabetes.

Keywords: health care utilization; malnutrition; mortality; retrospective study

Conflict of interest statement

Competing interests: All except JIM are shareholders and employees of Abbott. JIM has served in the advisory board of Abbott Nutrition and has been a compensated advisor of Abbott Nutrition.

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