Date of Conferral

2021

Degree

Ph.D.

School

Health Services

Advisor

David M. Segal

Abstract

Diabetes is one of America’s leading chronic diseases with comorbidities contributing to lower health statuses and increased health care costs. While it is known that lowering HbA1c reduces the deleterious effects of diabetes, the capability to identify people with diabetes at risk for uncontrolled HbA1c levels or developing comorbidities based on the compliance rates for different oral antihyperglycemic medication classes (OAMCs) and financial assistance programs does not yet exist. These quantitative longitudinal retrospective studies examined the association between medication compliance, using Proportion of Days Covered (PDC), by OAMC and Medicare financial aid programs, on predicting HbA1c levels and comorbidities in type 2 diabetics. Jaam’s medication compliance framework guided sample selection from the 2019 claims database of a large Managed Care Organization with limited eligibility of only 60% of the population which had an HbA1c level checked in the past 12 months. Multiple regression analyses revealed that as compliance rates improve, different OAMC combinations are associated with significant and variable reductions in A1c levels but with minimal effect strengths not allowing the linear regression model to be used as a predictive tool. Financial assistance programs have a small, but statistically significant effect on reducing HbA1c levels, comorbidities, or improving compliance rates. These studies are the first to investigate the association between PDC compliance rates for OAMCs on HbA1c and comorbidities. These findings contribute to positive social change by demonstrating that variable patient compliance rates for different OAMC medication classes and HbA1c testing should be considered when prescribing diabetic therapeutic regimens to achieve optimal HbA1c control and improved health status.

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