Objectives: <u></u>To study the relationship between social determinants of health (SDH), including health insurance status; accessibility to novel diabetes medications and technology; and health outcomes in people with diabetes (PWD).

Methods: A retrospective analysis of data from 311 PWD, who visited the same endocrinologist at either his public clinic (King Saud University) or private clinic (AlHabib Group) between Nov 2021 & Nov 2022 in Saudi. Metrics of glycemic control, cardiometabolic health, and utilization of diabetes medications and technology were compared by health insurance status.

Results: The median (IQR) age of the study participants was 40 (24, 60) years. Of them, 40.2% were insured. Most insured PWD (85.60%) were seen at the private clinic; and 97.85% of uninsured PWD were seen at the public clinic. Use of GLP-1 RA, SGLT-2 inhibitors, and combined diabetes medications were more prevalent among insured PWD (21.6%, 18.4%, and 15.2%, respectively) than uninsured PWD (8.60%, 5.38%, and 2.15%, respectively, all p<0.01). The insured group had a higher proportion of PWD with A1C of ≤8% compared to the uninsured group (64.66% vs 31.84%, respectively, p<0.01). Being insured was associated with greater odds of achieving an A1C of ≤8% [OR (95% CI): 6.07 (1.85, 19.91)] after adjusting for potential confounders, including sociodemographics, select SDH, and utilization of novel diabetes medications and technology. Among the 163 people with type 1 diabetes (PWT1D), use of insulin pumps was more common in insured versus uninsured PWT1D (28.57% vs 2.80%, respectively, p<0.01). The use of insulin pump was associated with greater odds of achieving an A1c of ≤8% in PWT1D [OR (95% CI): 4.28 (1.44, 12.72)].

Conclusion: Social determinants of health, including health insurance, play a key role in determining the health outcomes of PWD in Saudi. Differences in health outcomes by insurance status are likely driven by differences in availability of healthcare resources and other SDHs

Disclosure

M. Al-Sofiani: Consultant; Eli Lilly and Company. Speaker's Bureau; Medtronic, Insulet Corporation, Abbott, Sanofi. Consultant; Medtronic. Y. Alzamil: None.

© 2024 by the American Diabetes Association
2024
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