2203-P: Trajectories in Diabetes Care: A Longitudinal Cohort Study from China, England, South Africa, and the United States

Introduction and Objective: As global diabetes rates continue to rise, cross-sectional evidence consistently reveals large unmet care needs. We assess the extent to which individuals are initiated into, retained within, and advanced through diabetes care over time. Methods: We analyzed cohort data from 16,514 adults aged 40+ years from the 2012-2018 China, England, South Africa, and United States (US) health and retirement studies. From each study, we used two survey waves to describe diabetes diagnosis, treatment, and glycemic control at base- and endline. Specifically, we estimated i) repeated cross-sectional care cascades; ii) care transitions over time; and iii) socioeconomic associations considering death as competing risk. Results: Between 2012 and 2018, we find that only up to one in three adults with diabetes progressed to better care over time (Figure 1). In the US, almost half of undiagnosed adults remained so over the course of 4 years, while up to 10.9% adults with diabetes regressed in care. At the same time, over two thirds of adults transitioned from the diagnosis to the treatment stage. In the US, adults aged 60+ were significantly more likely to regress in care than those aged 50-59. Conclusion: All countries showed critical inertia and regression in diabetes care over 4 years. To meet the WHO Diabetes Coverage Targets, capacities to sustainably initiate, retain, and advance individuals in diabetes care need to improve. Disclosure M. Marcus: None. D. Flood: None. M. Theilmann: None. T. Kurth: Consultant; Current; AbbVie Inc. Other - Editorial services; Current; BMJ Group, Frontiers Media S.A. J. Manne-Goehler: None. N. Kumar: None. Funding The work by MEM leading to this publication was supported by the PRIME programme of the German Academic Exchange Service (DAAD) with funds from the German Federal Ministry of Education and Research (BMBF).