Health care access and glycemic control in youth and young adults with type 1 and type 2 diabetes in South Carolina

Abstract

Affordability and geographic accessibility are key health care access characteristics. We used data from 481 youth and young adults (YYA) with diabetes (389 type 1, 92 type 2) to understand the association between health care access and glycemic control as measured by HbA_1c values. In multivariate models, YYA with state or federal health insurance had HbA_1c percentage values 0.68 higher (P = 0.0025) than the privately insured, and those without insurance 1.34 higher (P < 0.0001). Not having a routine diabetes care provider was associated with a 0.51 higher HbA_1c (P = 0.048) compared to having specialist care, but HbA_1c did not differ significantly (P = 0.069) between primary vs specialty care. Distance to utilized provider was not associated with HbA_1c among YYA with a provider (P = 0.11). These findings underscore the central role of health insurance and indicate a need to better understand the root causes of poorer glycemic control in YYA with state/federal insurance.

Keywords: children's health; determinants of health; diabetes; health care access; insurance coverage.