Study Finds Association Between Increased Access to Diabetes Care Through Medicaid Expansion With Improved Health Outcomes


Patients who did not have health care coverage were found to have a significantly higher mean HbA1c levels among adults with diabetes.

Greater access to diabetes care, including through Medicaid expansion, is associated with improved health outcomes in younger adults with diabetes, according to the results of a study published in JAMA Network Open.

Diabetes | Image Credit: Sherry Young -

Sherry Young -

In the study, investigators analyzed data from a survey that was developed in 2 large, national cohort studies. The studies included the SEARCH for Diabetes in Youth, an observational study of individuals with type 1 diabetes (T1D) or type 2 diabetes (T2D) developed in youth; and the Treatment Options for Type 2 Diabetes in Adolescents and Youth (NCT00081328), a randomized clinical trial that was followed by an observational study.

The survey was administered in-person during visits in both studies from 2017 to 2019, with the analysis being performed between May 2021 and October 2022. The survey aimed to address health care coverage, usual sources of diabetes care, and frequency of care. Investigators analyzed glycated hemoglobin (HbA1c) levels and compared the patterns of health care factors and HbA1c levels compared by diabetes type.

There were 1371 individuals included in the study, with 661 having T1D and 250 having T2D from the SEARCH study and 460 having T2D from the TODAY study. Patients enrolled in the study had a mean diabetes duration of 11.8 years.

Investigators found that compared with patients with T2D, more patients with T1D in both studies reported health care coverage at 94.7%, 81.6%, and 86.7%, respectively, access to diabetes care at 94.7%, 78.1%, and 73.4%, respectively, and use of diabetes care at 88.1%, 80.5%, and 73.6%, respectively.

Additionally, patients who did not have health care coverage had significantly higher mean HbA1c levels for those with T1D at 10.8% compared to public insurance at 9.4% and private insurance at 8.7%. For individuals with T2D in the TODAY study, no coverage was 9.9%, public and private were both 8.7%.

Investigators also found that patients with T1D with Medicaid expansion had greater health care coverage compared to without expansion at 95.8% and 90.2%, respectively. For those in the SEARCH study, health care coverage was reported to be 86.1% and 73.9%, respectively, and in the TODAY study was 93.6% and 74.2%, respectively.

Furthermore, Medicaid expansion was associated with lower HbA1c levels at 9.2% compared to 9.7% without the expansion for individuals with T1D, 8.4% and 9.3%, respectively, for patients in the SEARCH study, and 8.7% compared to 9.3%, respectively, for patients in the TODAY study.

Investigators also reported that the T1D group had greater median monthly out-of-pocket expenses than patients in the T2D group at $74.50 and $10, respectively. The T1D group ranged from $10 to $309, whereas the T2D group ranged from $0 to $74.50.

Additionally, investigators said that the HbA1c results were inconsistent for those who had T2D. They also said that although it was shown that increased access to diabetes care can be associated with improved outcomes, additional strategies are needed for patients with T2D.

“Ensuring that processes and structures of care optimize access to diabetes care and health care coverage for younger adults with diabetes could play a role in lower HbA1c levels and improved health outcomes in this high-risk population,” the study authors wrote. “Effective education on optimizing diabetes care in younger adults is essential, given the sizeable portion of those who reported not seeking care because they rarely or never get sick yet had high mean HbA1c levels.”


Pihoker C, Braffett BH, Songer TJ, Herman WH, et al. Diabetes care barriers, use, and health outcomes in younger adults with type 1 and type 2 diabetes. JAMA Netw Open. 2023;6(5):e2312147. doi:10.1001/jamanetworkopen.2023.12147

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