People with diabetes who are required to switch to a high-deductible health plan (HDHP) due to an employer benefit change, are more likely to experience all long-term complications of diabetes examined in a recent study than those who are able to remain continuously enrolled in a non-HDHP. The risk increased with each year that the individual remained enrolled in an HDHP.
The odds of developing cardiovascular-related complications were 11% higher for heart attack. The odds of stroke were 15% higher, and the odds of being hospitalized for heart failure were 35% higher.
The odds of developing end-stage kidney disease were 153% higher. The odds of lower-extremity complications were 123% higher.
The odds of diabetes-related vision complications were 17% higher for proliferative retinopathy, and the odds of receiving treatment for retinopathy were 128% higher. The odds of blindness were 135% higher.
Each additional year of HDHP enrollment raised the risk of diabetes complications as follows:
- Heart attack risk increased by 7%.
- Stroke risk increased by 8%.
- Hospitalization for heart failure risk increased by 14%.
- End-stage kidney disease risk increased by 34%.
- Lower extremity complications increased by 33%.
- Proliferative retinopathy risk increased by 5%.
- Blindness increased by 31%.
- Needing treatment for retinopathy increased by 29%.
The researchers noted that preventing micro and macro vascular complications of diabetes requires monitoring and controlling hyperglycemia and cardiovascular risk factors. Because the HDHP model requires members to pay for costs out-of-pocket until they reach their deductible limits, the researchers proposed that the costs may have posed a barrier to obtaining services needed to manage the risk factors.
These findings were reported in “Enrollment in High-Deductible Health Plans and Incident Diabetes Complications” by Rozalina G. McCoy, M.D., MS; Kavya S. Swarna, MPH; David H. Jiang, BA; and colleagues. The researchers conducted a retrospective cohort study using deidentified administrative claims data for 245,055 U.S. adults with diabetes enrolled in employer-sponsored health plans between January 1, 2010, and December 31, 2019. In total 42,326 (17%) of the participants switched to an HDHP, and the remaining 202,729 did not switch. An HDHP is defined as a plan with an individual deductible of $1,400 or higher, and a family deductible of $2,800 or more; the member pays out-of-pocket for all costs up to the deductible.
For more information, contact: Rozalina McCoy, Associate Professor, Director of Precision Medicine and Population Health for the University of Maryland Institute for Health Computing (UM-IHC) and Associate Division Chief for Clinical Research, Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, Maryland 21201; Email: rozalina.mccoy@som.umaryland.edu; Website: https://www.medschool.umaryland.edu/profiles/mccoy-rozalina/