Socioeconomic Disparities in Follow-up Care for Young Adults with Type 1 Diabetes and Impact on Glycemic Control

dc.contributor.otherHsu, Jesseen
dc.contributor.otherLong, Judithen
dc.contributor.otherEiel, Jacken
dc.contributor.otherAgarwal, Shivamien
dc.creatorViroslav, Hannahen
dc.descriptionThe 56th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 23, 2018, 2-5 p.m., D1.600)en
dc.description.abstractBACKGROUND: Only 13% of young adults (YA) with type 1 diabetes (T1D), nationally, achieve the American Diabetes Association glycemic target of <7%. YA with T1D of low socioeconomic status (SES) have incrementally worse glycemic control, due to personal, social, and healthcare system factors. Engagement in regular diabetes follow-up has been shown to be beneficial in preventing acute complications and improving glycemic control in YA with T1D, but little is known whether disparities exist in follow-up care based on SES. The purpose of this study was to a) compare differences in diabetes follow-up patterns between low and higher SES YA with T1D and b) evaluate the impact of interrupted care on glycemic control. METHODS: 203 YA with T1D, 18-30 years, were recruited from the adult diabetes clinic at the University of Pennsylvania. Demographic, clinical, and follow-up visit data were extracted from medical charts. Low SES individuals were defined as having medical coverage under a federal or state-sponsored (public) insurance plan while higher SES individuals were defined as having coverage under a commercial (private) insurance plan. Baseline demographic and clinical characteristics were compared by insurance type. Multilevel mixed effects logistic and linear regression models were used to compare differences in follow-up rates and the impact on glycemic control. All models were adjusted for age, sex, race, diabetes duration, insulin regimen, and time in diabetes providerメs care. RESULTS: 203 participants were included for analysis. Mean age was 23.5 years and 55% were female. Forty-six percent (n=95) had public insurance and 53% (n=108) had private insurance; 42% (n=40) of publicly insured YA were black compared to 11% (n=12) of privately insured YA. Mean diabetes duration was 11.8 years with no significant difference between publicly and privately insured. Mean overall HbA1c was 9.0%, with mean HbA1c 9.9% for publicly insured and 8.8% for privately insured (p<0.001). Publicly insured YA were 1.5 times more likely to no show for scheduled visits (OR=1.53, p=0.009) and were 2.3 times more likely to be lost to diabetes follow-up after 6 months (OR 2.3, p<0.001), compared to privately insured YA. Glycemic control worsened substantially with each successive no show to a scheduled visit (HbA1c +1.10% per no show, p=0.001). CONCLUSION: Low SES YA with T1D are less likely to consistently follow up in diabetes care, are more likely to be completely lost to diabetes care after 6 months, and have worse glycemic control as a result of inconsistent follow-up, compared to higher SES YA. Further research needs to explore why disparities in follow-up exist, as well as innovative healthcare delivery modalities.en
dc.description.sponsorshipSouthwestern Medical Foundationen
dc.identifier.citationViroslav, H., Hsu, J., Long, J., Eiel, J., & Agarwal, S. (2018, January 23). Socioeconomic disparities in follow-up care for young adults with type 1 diabetes and impact on glycemic control. Poster session presented at the 56th Annual Medical Student Research Forum, Dallas, TX. Retrieved from
dc.relation.ispartofseries56th Annual Medical Student Research Forumen
dc.subjectClinical Researchen
dc.subject.meshDiabetes Mellitus, Type 1en
dc.subject.meshHealthcare Disparitiesen
dc.subject.meshSocial Classen
dc.subject.meshYoung Adulten
dc.titleSocioeconomic Disparities in Follow-up Care for Young Adults with Type 1 Diabetes and Impact on Glycemic Controlen
dc.title.alternativeDisparities in Follow-up Care for Young Adults with Type 1 Diabetes and Impact on Glycemic Controlen


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