Background/Purpose: Comorbidities are increasingly recognized as significant contributors of decreased quality of life, and increased mortality in RA. RA is associated with an increased risk of diabetes and cardiovascular mortality. Previous research suggests that RA populations receive sub-optimal care for their non-RA health related issues.

Our aim was to evaluate the quality of care for cardiovascular disease prevention in RA by measuring compliance with general population diabetes screening guidelines in RA compared to the general population.

Methods: We conducted a retrospective matched cohort study among patients with RA who received care between Jan 1996 and Mar 2006 and followed-up until Dec 2010. RA cases were selected if they had ≥2 MD visits more than 2 mos apart with an RA code. Cases were excluded if they had ≥2 subsequent MD visits for other inflammatory arthritis; if they saw a rheumatologist and RA diagnosis was never confirmed; or if there were no subsequent RA diagnoses over a follow-up > 5 yrs (N=36,458). Controls were selected from the general population and matched 1:1 to RA cases on gender, age, and calendar year. Administrative data was obtained on all physician visits, hospital admissions, tests ordered and medications.

Outcome: Compliance with current screening guidelines for diabetes defined as testing for plasma glucose (PG) at least once every 3 years for individuals ≥ 45years, excluding individuals with previous diabetes. Individuals’ follow-up was divided into 3-year eligibility windows, when they were eligible for the screening guideline. Each individual could contribute up to four three-year eligibility windows. Compliance was measured as the proportion of eligibility windows with at least one PG test performed within the time period. Compliance rates between RA and controls, using eligibility windows as the unit of analysis, were compared via a GEE model to account for the lack of independence of observations obtained from the same patient, adjusting for age and gender. Compliance rate per patient was also calculated, as the proportion of eligible windows per patient during follow-up when screening was performed. Mean compliance rates in the RA sample were compared to controls using a Mann-Whitney U test.

Results: We identified 27,650 individuals with RA (68.8% female, mean [SD] age 62.5 [12.9] yrs), contributing 49,515 three-year eligibility windows; and 30,486 controls (68.6% female, age 62.3 [12.9] yrs), contributing 62,942 three-year eligibility windows. Overall, PG was measured in 71.2% of the eligible time windows in the RA sample and in 74.4% for controls (OR=0.89 [95% CI; 0.86, 0.92], p<.0001). RA individuals met the recommended screening guidelines in 72.1% (SD=37.1%) of their eligible time windows, compared to 74.1% (SD=35.3%) for controls (p<.001).

Conclusion: Compliance with screening guidelines for diabetes was slightly lower in our RA cohort than the general population. Although the difference was statistically significant, it may not be a clinically relevant difference. Regardless, given the increased prevalence and burden of cardiovascular diseases in RA, diabetes screening is sub-optimal for RA individuals.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/quality-of-care-for-cardiovascular-prevention-in-ra-compliance-with-diabetes-screening-guidelines/