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Diabetes Quality of Care and Maintenance in New England: Can Cross-State Collaboration Move Us Forward?

PEER REVIEWED

A sign posted on a telephone pole says the following: Cash for sealed and unexpired diabetic test strips. 1-800-771-5589.

Figure 1.
Sign advertising offers to buy diabetes test strips. Photo produced by author.

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Figure 2.
Adjusted odds ratios for diabetes maintenance activities in 5 New England states, 2015 and 2016. Covariates were race/ethnicity, age group, education, sex, insurance (yes or no), sole adult in household, any leisure-time physical activity, current smoker, and state of residence. A, Adjusted odds ratio by FPL, where reference group is <200% of the FPL. B, Adjusted odds ratio by race/ethnicity, where reference group is non-Hispanic white. Error bars indicate 95% confidence intervals. Data sources: 2015 Connecticut BRFSS, 2015 Maine BRFSS, 2016 Massachusetts BRFSS, 2015 Rhode Island BRFSS, 2015 Vermont BRFSS. Abbreviations: BRFSS, Behavioral Risk Factor Surveillance System; FPL, federal poverty level; HbA1c, hemoglobin A1c.

Category Adjusted Odds Ratio (95% Confidence Interval)
Adjusted odds ratios for diabetes maintenance activities in 5 New England states, 2015 and 2016.
A, By Federal Poverty Level (FPL)
200-399% FPL
<2 HbA1c tests in past year 1.24 (0.73–2.11)
No eye examination in past year 0.80 (0.47–1.36)
No foot examination in past year 0.81 (0.46–1.44)
Incomplete annual diabetes care 0.91 (0.59–1.41)
Had never taken a course or class on diabetes self-management 1.13 (0.75–1.70)
Did not know the number of HbA1c tests received in past year or did not know what an HbA1c test is 0.57 (0.23–1.39)
Did not see provider about diabetes in past year 1.32 (0.67–2.58)
Never examines feet 1.16 (0.63–2.13)
Diabetes-related retinopathy 0.88 (0.48–1.63)
≥400% FPL
<2 HbA1c tests in past year 2.06 (1.04–4.08)
No eye examination in past year 0.77 (0.43–1.38)
No foot examination in past year 1.41 (0.79–2.53)
Incomplete annual diabetes care 1.45 (0.89–2.34)
Had never taken a course or class on diabetes self-management 0.83 (0.51–1.38)
Did not know the number of HbA1c tests received in past year or did not know what an HbA1c test is 0.20 (0.05–0.78)
Did not see provider about diabetes in past year 1.14 (0.45–2.89)
Never examines feet 1.48 (0.68–3.20)
Diabetes-related retinopathy 0.41 (0.22–0.75)
B, By Race/Ethnicity
Hispanic/Latino
<2 HbA1c tests in past year 1.21 (0.59–2.45)
No eye examination in past year 0.89 (0.47–1.68)
No foot examination in past year 1.83 (1.01–3.29)
Incomplete annual diabetes care 1.57 (0.83–2.98)
Had never taken a course or class on diabetes self-management 0.99 (0.57–1.75)
Did not know the number of HbA1c tests received in past year or did not know what an HbA1c test is 2.74 (1.15–6.56)
Did not see provider about diabetes in past year 0.87 (0.34–2.20)
Never examines feet 1.43 (0.73–2.82)
Diabetes-related retinopathy 3.13 (1.61–6.10)
Non-Hispanic black
<2 HbA1c tests in past year 1.29 (0.58–2.86)
No eye examination in past year 0.85 (0.36–1.99)
No foot examination in past year 0.90 (0.41–1.96)
Incomplete annual diabetes care 0.68 (0.31–1.51)
Had never taken a course or class on diabetes self-management 0.71 (0.32–1.61)
Did not know the number of HbA1c tests received in past year or did not know what an HbA1c test is 1.32 (0.45–3.91)
Did not see provider about diabetes in past year 0.84 (0.29–2.41)
Never examines feet 1.27 (0.53–3.07)
Diabetes-related retinopathy 1.08 (0.54–2.15)

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