Optimal Management of Diabetes Among Overweight and Obese Adults

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. Design: 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.