Utilization of Diabetes Self-Management Program among Breast, Prostate, and Colorectal Cancer Survivors: Using 2006-2019 Texas Medicare Data

Abstract

Purpose: Cancer treatment is associated with inferior health outcomes such as diabetes. Medicare provides Diabetes Self-Management Training (DSMT) program to beneficiaries to achieve normal metabolic control and reduce the risk of micro and macro-vascular complications. This study aimed to examine the trend of DSMT utilization among cancer survivors and assess individual characteristics associated with DSMT utilization. Methods: The data for this study was from Texas Cancer Registry-Medicare linkage data with prostate, breast, or colorectal cancer diagnosed in 1999-2017. Outcome variables include the number of first-time DSMT users, the number of total users, and the average number of DSMT utilization in minutes. We performed logistic regression and gamma regression to obtain multivariable-adjusted odds ratio for the association between DSMT utilization and individual characteristics. Results: The number of first-time users has slowly increased but suddenly dropped after 2016. The number of all users (first-time and follow-up users) has increased and remained plateau after 2016. Determinants including Hispanic ethnicity and Medicare-Medicaid dual eligibility are positively associated with both initiation and retention of DSMT. Barrier to both initiation and retention of DSMT is living in a metropolitan area. Conclusions: Multi-level strategies to enhance accessibility and availability of DSMT programs for Medicare beneficiaries are highly recommended. Implication to Cancer Survivors: Examining the DSMT utilization over 14 years provides insights on how to strengthen utilization to reduce burden of diabetes on cancer survivors.