Affordability and spatial accessibility are key dimensions of access to health care and important determinants of health. In populations with diabetes, evidence is largely limited to those with type 2 diabetes and older adults. We evaluated the association of insurance coverage and diabetes care provider characteristics with glycemic control in youth and young adults (YYA) with diabetes aged 6 to 30 years (median 16 years), participating in the SEARCH for Diabetes in Youth study in South Carolina between January 2012 and July 2015. A total of 540 YYAs with diabetes (437 type 1, 103 type 2) provided information on health insurance type, diabetes care provider (type and address); HbA1c was measured in-person. Geographic information systems were used to calculate distance to the reported provider. Multivariate linear regression analyses were utilized to evaluate the association. More than half of YYAs with diabetes utilized state/federal insurance (46%) or were uninsured (18%). Only 79% indicated a diabetes care provider. The majority (62%) were seeing an endocrinologist, traveling 27 miles on average (median 16 miles). Average HbA1c was 9.2%. Compared to those with private insurance, YYAs with state/federal health insurance had 0.78 higher HbA1c levels (p<.001) and those with no insurance had 1.1 higher HbA1c (p<.0001), independent of age, sex, race/ethnicity, urbanicity, diabetes type, duration, and medication regimen. Compared to receiving care by an endocrinologist, reporting care by a primary care provider was associated with a 0.6 higher HbA1c (p=.028) and a 0.8 higher level (p=.007) with no routine diabetes care provider reported. Distance to provider was not associated with glycemic control (p=.18).

In summary, health insurance status and type, and provider type were significantly associated with glycemic control. This study underscores the importance of social determinants of health on diabetes management outcomes in youth and young adults.


A.D. Liese: None. X. Ma: None. L. Reid: None. J.M. Eberth: None. B.A. Bell: None. J. Probst: None. C.B. Turley: Stock/Shareholder; Self; AbbVie Inc., Johnson & Johnson Services, Inc., Pfizer Inc., CVS/Caremark, Amgen Inc., Walgreen Co., UnitedHealth Group, Novartis AG, Abbott. E.J. Mayer-Davis: None.

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