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Healthcare Coverage and Glycemic Control in Young Adults with Youth-Onset Type 2 Diabetes: Results from the TODAY2 Study

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posted on 10.08.2020 by The TODAY Study Group, Writing Committee:, Ruth S. Weinstock, Barbara H. Braffett, Thomas J. Songer, William H. Herman, Shihchen Kuo, Rose A. Gubitosi-Klug, Lori Laffel, Siripoom McKay, Maggie Siska, Michelle Van Name, Philip S. Zeitler
Objective: To examine the relationship between healthcare coverage and HbA1c in young adults with youth-onset type 2 diabetes who transitioned to community diabetes care after receiving care during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.

Research Design and Methods: Participants completed questionnaires annually. HbA1c was measured in a central laboratory. Data from 2 years before and after transitioning to community care (2013-2016) were examined and compared between states with and without expanded Medicaid.

Results: In 2016 (n=427, mean age 24 years), two years after transitioning to community care, 93% of participants in states with Medicaid expansion had healthcare coverage compared to 68% (p<0.0001) in states without Medicaid expansion. Mean HbA1c was 9.8% in participants with government coverage, 9.3% with commercial coverage, and 10.1% in those with no coverage (p=0.0774). Additionally, 32%, 42%, and 66% of government, commercial covered, and no coverage, respectively, were not attending outpatient diabetes visits (p<0.0001). Of those with government coverage, 83% reported they had adequate coverage for insulin syringes/needles/pens, and 89% for glucose monitoring supplies, with more limited coverage in those with commercial plans. Participants with commercial coverage had higher education attainment (p<0.0001); 52% had HbA1c ≥9.0% compared to 64% of government covered and 58% with no coverage (p=0.0646).

Conclusions: More young adults with type 2 diabetes from the TODAY cohort had healthcare coverage in states with expanded Medicaid but glycemic control remained poor, regardless of coverage. New therapies and approaches are needed for this vulnerable population.

Funding

This work was completed with funding from NIDDK and the NIH Office of the Director through grants U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The NIDDK project office was involved in all aspects of the study, including: design and conduct; collection, management, analysis, and interpretation of the data; review and approval of the manuscript; and decision to submit the manuscript for publication.

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