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The impact of insurance coverage and the family on pediatric diabetes management
Author(s) -
Watson Sara E,
Kuhl Evan A,
Foster Michael B,
Omoruyi Adetokunbo O,
Kingery Suzanne E,
Woods Charles,
Wintergerst Kupper A.
Publication year - 2017
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12394
Subject(s) - medicine , glycemic , diabetes mellitus , insulin , type 1 diabetes , diabetes management , population , private insurance , type 2 diabetes , pediatrics , health insurance , endocrinology , health care , environmental health , economic growth , economics
Background/Objective The impact of family composition on glycemic control in children with type 1 diabetes remains unclear. We sought to evaluate the relationship between health insurance coverage, family composition, and insulin management, and assess their impact on glycemic control in a pediatric type 1 diabetes population. Methods A retrospective chart review was completed for patients seen in the Pediatric Endocrinology Clinic at the University of Louisville in 2012. Results The analysis included 729 patients with type 1 diabetes; 268 (37%) had public insurance while 461(63%) had private insurance. Compared with publicly insured patients, privately insured patients had higher rates of intensive insulin management with multiple daily injections ( MDI ) plans or pump devices (88 vs. 83.2%, p = 0.066) and lower HbA1c levels [8.57 vs. 9.39% (70 vs. 79 mmol/mol), p < 0.001]. Of the 729 patients, 243 were in single‐adult homes (33%). Single‐adult homes had higher HbA1c levels than two‐adult homes, [9.3 vs. 8.6% (78 vs. 70 mmol/mol), p < 0.001]. Among publicly insured, there was no difference in HbA1c levels for single‐adult vs. two‐adult homes [9.4 (79 mmol/mol), p = 0.868]. For privately insured, patients in single‐adult homes had higher HbA1c levels than peers in two‐adult homes [9.2 vs. 8.4% (77 vs. 68), p < 0.001]. Conclusion Insurance type and family composition have significant associative effects on glycemic control and insulin management that may be mitigated by insulin pump therapy. Identifying and addressing factors such as availability of resources, family education, and adult support and supervision, may help improve glycemic control in high‐risk pediatric diabetes patients.