The impact of health insurance coverage on pediatric diabetes management

Wintergerst, Kupper A.; Hinkle, Krystal M.; Barnes, Christopher N.; Omoruyi, Adetokunbo O.; Foster, Michael B.

doi:10.1016/j.diabres.2010.06.013

« Previous Next »Diabetes Research and Clinical Practice
Volume 90, Issue 1 , Pages 40-44, October 2010

The impact of health insurance coverage on pediatric diabetes management

Kupper A. Wintergerst
- Department of Pediatrics, Division of Endocrinology, School of Medicine, University of Louisville, 571 South Floyd Street, Louisville, KY 40202, USA
- Corresponding author. Tel.: +1 502 852 4347; fax: +1 502 852 4189.
Krystal M. Hinkle
- Department of Pediatrics, Division of Endocrinology, School of Medicine, University of Louisville, 571 South Floyd Street, Louisville, KY 40202, USA
Christopher N. Barnes
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40202, USA
Adetokunbo O. Omoruyi
- Department of Pediatrics, Division of Endocrinology, School of Medicine, University of Louisville, 571 South Floyd Street, Louisville, KY 40202, USA
Michael B. Foster
- Department of Pediatrics, Division of Endocrinology, School of Medicine, University of Louisville, 571 South Floyd Street, Louisville, KY 40202, USA

Received 22 March 2009; received in revised form 6 May 2010; accepted 10 June 2010. published online 14 July 2010.

Abstract

Aims

To examine the association between health insurance coverage, insulin management plans, and their impact on diabetes control in a pediatric type 1 diabetes mellitus clinic population.

Methods

Retrospective cohort design drawn from the medical records of the Pediatric Endocrinology Clinic at the University of Louisville, Kentucky.

Results

Out of 701 patients, 223 had public insurance, and 478 had private insurance. 77% of publically insured used two or three injections per day vs. 40% private. Conversely, 58% of privately insured used a multiple daily injection (MDI) plan or insulin pump (vs. 21%). 84% of MDI patients had private insurance with 93% using insulin pens compared with 38% of publically insured. Mean HbA1c was 8.6% for privately insured vs. 9.8% public, p<0.0001. Privately insured MDI and pump patients had the lowest HbA1cs.

Conclusions

Insurance type had a significant effect on the insulin management plan used and was the most significant factor in overall diabetes control. Limitations on insulin pen use and number of glucose test strips may play a role in the decreased use of MDI/insulin pumps by publicly insured patients. Addressing factors related to insurance type, including availability of resources, could substantially improve diabetes control in those with public insurance.

Keywords: Insurance, Insulin, Diabetes type 1