Electronic Theses and Dissertations

Title

Type 2 Diabetes in Children: Estimates of Epidemiology, Quality of Care, Costs and Resource Utilization in a Medicaid Population

Date of Award

2010

Document Type

Dissertation

Degree Name

M.S. in Pharmaceutical Science

First Advisor

Yi Yang

Second Advisor

John Bentley

Third Advisor

Benjamin F. Banahan

Abstract

Objective: the primary goal of this study was to assess the current state of diabetes, specifically type 2 diabetes in Mississippi Medicaid enrolled pediatric population. Background: Diabetes is the most prevalent pediatric chronic condition. Recent trends indicate that type 2 diabetes in children is increasing. Epidemiology estimates of type 2 diabetes in children and adolescents are limited. Quality of care and their health care utilization estimates are not available. Methods: 2002 - 2004 Mississippi Medicaid claims data were used for this study. A combination of ICD-9 codes (250.0x - 250.9x, where x=0 or 2) and/or oral hypoglycemic (OHG) drug use were used to identify children with type 2 diabetes. Sociodemographic characteristics, risk factors, comorbidities and complications were assessed for all diabetes children. Medication use/adherence and their association with hospitalization and economic outcomes were explored. We also assessed annual screening rates in the type 2 diabetes population. Annual health care resource utilization and expenditures were assessed and modeled using Poisson regression and GLM with gamma distribution and log link respectively. Results: Overall, a sizeable proportion of children enrolled in Mississippi have diabetes, especially type 2 diabetes. Very few children with type 2 diabetes use oral hypoglycemic and antihypertensive medications, even fewer children use antihyperlipidemics. Among users, adherence was poor. Adherence with annual screenings was also suboptimal in this population indicating poor management of type 2 diabetes overall. Children with both diabetes types have higher healthcare resource utilization and expenditures compared to all Medicaid enrolled children without diabetes and pediatric population with asthma and ADHD. Conclusions: type 2 diabetes is prevalent in children enrolled in Mississippi Medicaid and most of these children don't receive optimal care. Healthcare providers should inform patients and children the implications of mismanagement and Medicaid should offer provider incentives to encourage healthcare providers to implement effective interventions.

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