For a sample of continuously-insured adolescents/young adults (AYA, ages 13-26) with T1D enrolled in a national managed care plan from 2013-2016 (16,500 person-years among 8,694 AYA), we describe frequency of medical visits, types of physicians (specialist vs. primary care; pediatric vs. adult) delivering care, and receipt of recommended diabetes monitoring tests. Over 75% of all outpatient visits for 13 year olds (yo) were to pediatric physicians, declining to 2.5% of visits for 26yo; access to specialty care declined from 82% of 13yo to 68% of 26yo. Those receiving ≥twice yearly A1c tests declined from 83% of 13yo to 60% of 26yo, while receiving annual LDL or microalbumin tests rose from 51% of 13yo to 60% of 26yo. Those not accessing specialty care were the least likely to receive recommended tests (A1c odds ratio [OR]:0.26, 95%CI:0.23-0.29; LDL OR:0.61, 95%CI:0.55-0.67; microalbumin OR:0.50, 95%CI:0.46-0.56). Those receiving the majority of care from adult specialists had lower odds of receiving recommended tests (A1c OR:0.61, 95%CI:0.54-0.69; microalbumin OR:0.90, 95%CI:0.82-0.99) compared to those receiving care from pediatric specialists. Despite continuous insurance, many AYA don’t access any specialty care and are less likely to receive routine diabetes monitoring tests as a result. There is large variation in physician types visited by AYA and measurable differences in testing by specialty type.
L.E. Wisk: None. M. Landrum: None. C. Fu: None. A. Chien: None.
National Institute of Diabetes and Digestive and Kidney Diseases (K01DK116932 to L.E.W.); Agency for Healthcare Research and Quality (U19HS024072 to A.C.)