Health care access and glycemic control in youth and young adults with type 1 and type 2 diabetes in South Carolina

Liese, Angela D.; Ma, Xiaonan; Reid, Lauren; Sutherland, Melanie W.; Bell, Bethany A.; Eberth, Jan M.; Probst, Janice C.; Turley, Christine B.; Mayer‐Davis, Elizabeth J.

doi:10.1111/pedi.12822

Cited by 18 publications

(16 citation statements)

References 53 publications

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“…8,9 Health insurance status has been shown to be strongly associated with glycemic control in YYA with type 1 diabetes. 10,11 Additionally, living in a household with low SEP places a person at a high risk for food insecurity. 12 Food insecurity describes "limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in social acceptable ways" 13 and may impact several facets of diabetes care, including adherence to nutrition guidelines, physical activity, and diabetes self-management.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic position is associated with glycemic control in youth and young adults with type 1 diabetes

Sutherland

Reboussin

et al. 2020

Pediatric Diabetes

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Objective: Health inequities persist in youth and young adults (YYA) with type 1diabetes in achieving optimal glycemic control. The purpose of this study was to assess the contribution of multiple indicators of social need to these inequities. Research design and methods: Two hundred and twenty two YYA withtype 1 diabetes enrolled in the SEARCH Food Insecurity Study in South Carolina and Washington between the years 2013 and 2015 were included. Latent class analysis was used to identify socioeconomic profiles based on household income, parental education, health insurance, household food insecurity, and food assistance. Profiles were evaluated in relation to glycemic control using multivariable linear and logistic regression, with HbA1c > 9%(75 mmol/mol) defined as high-risk glycemic control. Results: Two profiles were identified: a lower socioeconomic profile included YYA whose parents had lower income and/or education, and were more likely to be uninsured, receive food assistance, and be food insecure. A higher socioeconomic profile included YYA whose circumstances were opposite to those in the lower socioeconomic profile. Those with a lower socioeconomic profile were more likely to have high-risk glycemic control relative to those with a higher socioeconomic profile (OR = 2.24, 95%CI = 1.16-4.33). Conclusions: Lower socioeconomic profiles are associated with high-risk glycemic control among YYA with type 1 diabetes. This supports recommendations that care providers of YYA with type 1 diabetes assess individual social needs in tailoring diabetes management plans to the social context of the patient.

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Section: Introductionmentioning

confidence: 99%

“…Low‐SEP persons often lack health insurance or are underinsured, and the demands of co‐pays and non‐covered items (eg, glucose test strips) can lead to medication under use 8,9 . Health insurance status has been shown to be strongly associated with glycemic control in YYA with type 1 diabetes 10,11 12 …”

Section: Introductionmentioning

confidence: 99%

Socioeconomic position is associated with glycemic control in youth and young adults with type 1 diabetes

Sutherland

Reboussin

et al. 2020

Pediatric Diabetes

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“…Of the 2777 participants who completed the first and/or second Tukey P < .001). Further, the lowest A1c (8.5% [SE 0.5]) was observed among participants who reported never counting carbohydrates, but T A B L E 1 Characteristics of SEARCH participants that completed two to three questionnaires on use of dietary strategies to manage diabetes over (mean) 5.5 years and provided a blood sample for analysis of hemoglobin A1c at the last follow-up visit (n = 1814) 17,18 and food insecurity 19 that are associated with higher A1c.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, we note that A1c is higher than recommended in all participants, 2 regardless of self‐reported use of any particular dietary strategy. This highlights the need for additional glycemic control strategies in this population, such as intensification of therapy, or addressing social determinants of health like barriers to health care access 17,18 and food insecurity 19 that are associated with higher A1c.…”

Section: Discussionmentioning

confidence: 99%

Dietary strategies to manage diabetes and glycemic control in youth and young adults with youth‐onset type 1 and type 2 diabetes: TheSEARCHfor diabetes in youth study

et al. 2020

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Aims: Examine associations of dietary strategies used to manage diabetes over time with hemoglobin A1c in youth-onset type 1 or type 2 diabetes. Methods: The SEARCH for Diabetes in Youth observational study assessed dietary strategies used by 1814 participants with diabetes (n = 1558 type 1, n = 256 type 2) at two to three research visits over 5.5 years (range 1.7-12.2). Participants reported often, sometimes, or never using 10 different dietary strategies, and use over time was categorized into five mutually exclusive groups: often using across visits; started using at later visits; sometimes using across visits; stopped using at later visits; or never using across visits. General multivariable linear models evaluated most recent A1c by use category for each strategy. Results: In type 1 diabetes, A1c was lower among those who starting tracking calories (−0.4%, Tukey P < .05), often counted carbs (−0.8%, Tukey P < .001), or sometimes chose low glycemic index foods (−0.5%, Tukey P = .02) vs those with less use, while participants who never drank more milk had the lowest A1c (−0.5%, Tukey P = .04). In type 2 diabetes, A1c was lower among those who often limited high fat

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“…The role of glycemic control in preventing the development and progression of complications has been proven in diabetes [35][36][37][38], with an especially strong relationship identified between intensive glycemic control and diabetic complications and mortality. In general, a target HbA 1c level of less than 7% is optimal, according to diabetes guidelines [14].…”

Section: Comparison With Prior Workmentioning

confidence: 99%

A Mobile-Based Intervention for Glycemic Control in Patients With Type 2 Diabetes: Retrospective, Propensity Score-Matched Cohort Study

Sun

Wang

et al. 2020

JMIR Mhealth Uhealth

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Background Mobile-based interventions appear to be promising in ameliorating huge burdens experienced by patients with type 2 diabetes. However, it is unclear how effective mobile-based interventions are in glycemic management of patients with type 2 diabetes based on real-world evidence. Objective This study aimed to evaluate the effectiveness of a mobile-based intervention on glycemic control in patients with type 2 diabetes based on real-world population data. Methods This retrospective, propensity score-matched cohort study analyzed longitudinal data from a clinical electronic health database. The study population included 37,913 patients with type 2 diabetes at cohort entry between October 1, 2016, and July 31, 2018. A total of 2400 patients were matched 1:1, using propensity score matching, into the usual care and mobile health (mHealth) groups. The primary outcomes of glycemic control included control rates of glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and postprandial 2-hour blood glucose (P2BG). Mean values and variation trends of difference with 95% CI were the secondary outcomes. The general linear model was used to calculate repeated-measures analyses of variance to examine the differences between the two groups. Subgroup and sensitivity analyses were performed. Results Of the 2400 patients included in the analysis, 1440 (60.00%) were male and the mean age was 52.24 years (SD 11.56). At baseline, the control rates of HbA1c, FBG, and P2BG in the mHealth and usual care groups were 45.75% versus 47.00% (P=.57), 38.03% versus 32.76% (P=.07), and 47.32% versus 47.89% (P=.83), respectively. At the 3-, 6-, 9-, and 12-month follow-ups, the mHealth group reported higher control rates of HbA1c than did the usual care group: 69.97% versus 46.06% (P<.001), 71.89% versus 61.24% (P=.004), 75.38% versus 53.44% (P<.001), and 72.31% versus 46.70% (P<.001), respectively. At the four follow-up sessions, the control rates of FBG in the mHealth and usual care groups were statistically different: 59.24% versus 34.21% (P<.001), 56.61% versus 35.14% (P<.001), 59.54% versus 34.99% (P<.001), and 59.77% versus 32.83% (P<.001), respectively. At the four follow-up sessions, the control rates of P2BG in the mHealth group were statistically higher than in the usual care group: 79.72% versus 48.75% (P<.001), 80.20% versus 57.45% (P<.001), 81.97% versus 54.07% (P<.001), and 76.19% versus 54.21% (P=.001), respectively. At the four follow-up sessions, the percentages of HbA1c reduction in the mHealth group were 8.66% (95% CI 6.69-10.63), 10.60% (95% CI 8.66-12.54), 10.64% (95% CI 8.70-12.58), and 8.11% (95% CI 6.08-10.14), respectively. At the four follow-up sessions, the percentages of P2BG reduction in the mHealth group were 8.44% (95% CI 7.41-10.73), 17.77% (95% CI 14.98-20.23), 16.23% (95% CI 13.05-19.35), and 16.91% (95% CI 13.17-19.84), respectively. Starting from the sixth month, the mean HbA1c and P2BG values in the two groups increased slightly. Conclusions This mobile-based intervention delivered by a multidisciplinary team can better improve glycemic control rates of patients with type 2 diabetes than usual care. These effects were best sustained within the first 6 months. Starting from the sixth month, intensive management needs to be conducted to maintain long-term effectiveness of the mobile-based intervention.

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Health care access and glycemic control in youth and young adults with type 1 and type 2 diabetes in South Carolina

Cited by 18 publications

References 53 publications

Socioeconomic position is associated with glycemic control in youth and young adults with type 1 diabetes

Socioeconomic position is associated with glycemic control in youth and young adults with type 1 diabetes

Dietary strategies to manage diabetes and glycemic control in youth and young adults with youth‐onset type 1 and type 2 diabetes: TheSEARCHfor diabetes in youth study

A Mobile-Based Intervention for Glycemic Control in Patients With Type 2 Diabetes: Retrospective, Propensity Score-Matched Cohort Study

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