Annual Wellness Visits Reduce Likelihood of Amputation for Patients With Diabetes

Patients with diabetes who participate in a free annual wellness visit (AWV) covered by Medicare are 36% less likely to need major lower-extremity amputations (MLEAs), according to research presented last month at the American Diabetes Association’s Scientific Sessions in New Orleans.¹

AWVs are yearly visits for fee-for-service (FFS) Medicare beneficiaries that include discussing preventive care needs and scheduling future preventive care services, which helps to increase the use of these services among patients with diabetes.

Data from 2006 to 2015 on 900,000 Medicare FFS beneficiaries living in the so-called Diabetes Belt were studied to determine whether AWVs are associated with reduced risk of MLEAs.

The Diabetes Belt includes 644 counties in the Deep South and Appalachian regions of the United States with higher rates of diabetes, including the state of Mississippi and parts of Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and West Virginia.

Although the study found that patients living in the Diabetes Belt had 27% greater odds of requiring a lower-extremity amputation compared with residents of counties surrounding the belt, the rate of MLEAs was found to be significantly lower among patients in the Diabetes Belt who had an AWV in the last year compared with those who had not.

Patients living in the Diabetes Belt also had lower diagnosis rates of diabetes-related foot complications compared with those in surrounding counties. The authors suggest that this may point to delayed diagnoses that can lead to amputation.

Odds of amputation were 36% lower for patients who used their free AWV that year compared with those who did not attend an AWV.

AWVs may lead to earlier diagnoses of foot complications, helping prevent amputations, the researchers believe.

The researchers also suggest that patients who use their AWVs may be more engaged in their care, which may reduce risk of serious complications.

“Our results confirmed our hypothesis that [AWVs] are associated with a reduced risk of major lower-extremity amputations, highlighting the importance of connecting patients to preventive care services,” said coauthor Jennifer Lobo, PhD, a researcher in the University of Virginia’s Department of Public Health Sciences, according to a UVA Health news release.

The study also found significantly higher rates of diabetes-related amputations among non-Hispanic Black patients compared with non-Hispanic White patients both inside and outside the Diabetes Belt.

“While [AWVs] are a free visit for qualified Medicare beneficiaries, additional incentives or resources to overcome systemic access to care barriers are needed to support patient attendance,” Lobo said.

In a separate abstract presented at the meeting, the same team of authors examined technical efficiency by measuring outputs including the number of foot exams, glycated hemoglobin (A1C) tests, and microalbumin tests per 1000 Medicare beneficiaries with diabetes in the Diabetes Belt that were produced by the number of physicians and nurses per 1000 adults in the counties.

The average technical efficiency of the 861 counties studied ranged from 79% to 83%. Only 2% to 3.4% of counties achieved 100% technical efficiency.

Counties in the Diabetes Belt were found to have consistently lower efficiency than surrounding counties, with lower mean efficiency of 78% to 81% in the Diabetes Belt lower vs a mean of 81% to 85% in the surrounding counties.

The researchers suggested that the degree of inefficiency was higher in the Diabetes Belt due to relatively low available resources in these areas, which need to be addressed in order to boost preventive care efforts.

References

1. Lobo JM, Kim S, Kang H, Sohn MW. Association between annual wellness visits and major amputations among Medicare beneficiaries in the Diabetes Belt. Diabetes. 2022;71(suppl 1):122-OR. doi:10.2337/db22-122-OR

2. Kang H, Kim S, Lobo JM, Sohn MW. Diabetes preventive care for Medicare beneficiaries: comparing efficiency between the Diabetes Belt and surrounding areas. Diabetes. 2022;71(suppl 1):921-P. doi:10.2337/db22-921-P