Diabetes Care Barriers, Use, and Health Outcomes in Younger Adults With Type 1 and Type 2 Diabetes
Authors' conclusion
Results of this study suggested that lack of health care coverage and of an established source of diabetes care were associated with significantly higher HbA1c levels for participants with T1D, but inconsistent results were found for participants with T2D. Increased access to diabetes care (eg, through Medicaid expansion) may be associated with improved health outcomes, but additional strategies are needed, particularly for individuals with T2D.
Study context
- Population
- Younger adults with youth-onset T1D or T2D; mean age 25 (range 18–36) years; 60.1% female; mean diabetes duration 11.8 (SD 2.8) years; surveyed 2017–2019
- Participants
- 1,371 adults
- Exposure
- Health care coverage, access and use of diabetes care and HbA1c by diabetes type (T1D vs T2D)
- T1D (SEARCH)n = 661
- T2D (SEARCH)n = 250
- T2D (TODAY)n = 460
- Outcome
- Health care coverage, usual sources of diabetes care, frequency of care use, and HbA1c, compared by diabetes type
Methodological detailssurvey of 2 national cohort studies (SEARCH and TODAY), interviewer-directed survey, Survey administered at in-person visits 2017-2019; analyses May 2021-October 2022
- Survey of 2 national cohort studies (SEARCH and TODAY)
- Interviewer-directed survey
- Survey administered at in-person visits 2017-2019; analyses May 2021-October 2022
Main finding
As reported in the abstract
Health care coverage, access to and use of diabetes care
Access to diabetes care
Use of diabetes care
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Mean (SE) HbA1c by coverage, T1D (SEARCH)No coverage vs Public / private | P < 0.001 |
| Mean (SE) HbA1c by coverage, T2D (TODAY)No coverage vs Public / private | P = 0.004 |
- Mean (SE) HbA1c by coverage, T1D (SEARCH) — No coverage
- 10.8% (SE 0.5%)
- Mean (SE) HbA1c by coverage, T1D (SEARCH) — Public
- 9.4% (SE 0.2%)
- Mean (SE) HbA1c by coverage, T1D (SEARCH) — Private
- 8.7% (SE 0.1%)
- Mean (SE) HbA1c by coverage, T2D (TODAY) — No coverage
- 9.9% (SE 0.3%)
- Mean (SE) HbA1c by coverage, T2D (TODAY) — Public
- 8.7% (SE 0.2%)
- Mean (SE) HbA1c by coverage, T2D (TODAY) — Private
- 8.7% (SE 0.2%)
Health care coverage, Medicaid expansion vs without expansion
- T1D
- 95.8% vs 90.2%
- T2D (SEARCH)
- 86.1% vs 73.9%
- T2D (TODAY)
- 93.6% vs 74.2%
HbA1c, Medicaid expansion vs without expansion
- T1D
- 9.2% vs 9.7%
- T2D (SEARCH)
- 8.4% vs 9.3%
- T2D (TODAY)
- 8.7% vs 9.3%
Monthly out-of-pocket expenses, T1D vs T2D
- T1D, median (IQR)
- $74.50 [$10.00-$309.00]
- T2D, median (IQR)
- $10.00 [$0-$74.50]
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →