Socioeconomic Disparities in Outpatient Diabetes Care Patterns for Young Adults with Type 1 Diabetes

• Published in: Diabetes (New York, N.Y.) Vol. 67; no. Supplement_1
• Main Authors: AGARWAL, SHIVANI, VIROSLAV, HANNAH L., EIEL, JACK N., LONG, JUDITH A.
• Format: Journal Article
• Language: English
• Published: 01-07-2018
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db18-1381-P

Background: Few young adults (YA) with type 1 diabetes (T1D) achieve national glycemic targets, and even fewer of low socioeconomic status (SES) meet these goals. Inconsistent clinic attendance is thought to contribute to this disparity in glycemic control but has not been studied.
Methods: We evaluated clinic attendance in YA with T1D, 18-25 years, seen in a young adult diabetes clinic. We extracted data from medical charts and used insurance status to identify low and higher SES YA, comparing individuals with federal/state-sponsored (public) insurance to commercial (private) insurance. Glycemic control was defined as the difference between the last documented A1c and the baseline first appointment A1c. There were 2 outcomes representing inconsistent attendance: 1) missing ≥1 scheduled quarterly visit per year and 2) gap in care >6 months. We used multilevel mixed effects linear and logistic regression models to examine relationships between insurance status, inconsistent attendance, and glycemic control, adjusting for demographic, clinical, social, and health system factors.
Results: 312 YA were seen in the clinic (mean age 23.5 years) totaling 2376 care visits. Forty-six percent (n=147) had public insurance. Publicly insured YA were more frequently black (42% vs. 11%, p<0.001) and in worse glycemic control (mean baseline A1c 9.9% vs. 8.1%, p<0.001). In multivariate analyses, compared to privately insured YA, publicly insured were 50% more likely to miss a quarterly appointment (OR=1.56, p=0.005) and 96% more likely to have a gap in care >6 months (OR 1.96, p=0.008). In addition, missed appointments worsened glycemic control from baseline (A1c +0.57%, p<0.001).
Conclusions: Low SES YA with T1D are a particularly high-risk subset who are more likely to miss appointments and have gaps in care, which is associated with worse glycemic control. Our results highlight the need to refocus on improving follow-up rates in vulnerable populations to address disparities in glycemic outcomes.