Background: Established diabetes care (“diabetes home”) and regular healthcare visits are important to achieve good outcomes. Nothing is known about psychosocial factors that predict healthcare usage (HCU) in young adults with youth-onset type 2 diabetes.

Objective: To identify psychosocial predictors of HCU in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort.

Design: Longitudinal, measured at T1 (baseline) and T2 (1 year later). Logistic and linear regressions, adjusted for covariates, were used to identify predictors of sub-optimal HCU (defined as no diabetes home, 0 routine care visits, ≥1 urgent care visit in prior 6 months).

Participants: N= 366 TODAY2 participants. Mean age=26.0 years, 67.8% female, 37.7% non-Hispanic Black, 35.8% Hispanic, 20.2% non-Hispanic white, mean HbA1c=9.4%.

Main measures: HCU survey; reliable, valid measures of diabetes self-efficacy, depressive symptoms, anxiety symptoms, diabetes distress, beliefs about medicines, diabetes attitudes, material need insecurities and self-management support.

Key Results: 25.4% had no diabetes home, 23.7% had 0 routine care visits, 46% had ≥1 urgent care visit in prior 6 months. Beliefs in the necessity of (p<0.001), and concerns about (p=0.004), diabetes medicines, and diabetes having negative psychosocial impacts (p=0.034), predicted higher odds of having a diabetes home at T2. Beliefs that medicines are harmful predicted lower odds of having a diabetes home (p=0.006). Necessity beliefs (p=0.002), concerns (p=0.025), and self-management support (p=0.014) predicted higher odds of having ≥ 1 diabetes care visit in prior 6 months, harm beliefs predicted lower odds (p=0.005).

Conclusions: Sub-optimal healthcare usage is common in young adults with youth-onset type 2 diabetes and is predicted by beliefs about medicines and self-management support. We must address these factors to help this vulnerable group establish a stable foundation for diabetes care.


P.M.Trief: None. D.Uschner: None. B.Anderson: None. H.Wen: None. J.D.Bulger: None. R.S.Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc.


National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110456)

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