Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study

Braffett, Barbara H.; Songer, Thomas J.; Herman, William H.; Kuo, Shihchen; Gubitosi-Klug, Rose; Laffel, Lori M.; McKay, Siripoom; Siska, Maggie; Name, Michelle Van; Zeitler, Philip

doi:10.2337/dc20-0760

Cited by 14 publications

(7 citation statements)

References 28 publications

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“…As with all claims-based research, our study has limitations. First, our population with type 2 diabetes differs demographically from other reports . This may relate to data source, as race and socioeconomic variables are imputed.…”

Section: Discussionmentioning

confidence: 99%

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes

March,

Byerly,

Siminerio

et al. 2024

JAMA Netw Open

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ImportanceYouths with type 2 diabetes are at higher risk for complications compared with peers with type 1 diabetes, though few studies have evaluated differences in access to specialty care.ObjectiveTo compare claims with diabetes specialists for youths with type 1 vs type 2 diabetes and the association between specialist claims with multidisciplinary and acute care utilization.Design, Setting, and ParticipantsThis cross-sectional study used Optum Clinformatics Data Mart commercial claims. Individuals included in the study were youths younger than 19 years with type 1 or 2 diabetes as determined by a validated algorithm and prescription claims. Data were collected for youths with at least 80% enrollment in a commercial health plan from December 1, 2018, to December 31, 2019. Statistical analysis was performed from September 2022 to January 2024.Main Outcomes and MeasuresThe primary outcome was the number of ambulatory claims from an endocrine and/or diabetes physician or advanced practice clinician associated with a diabetes diagnosis code; secondary outcomes included multidisciplinary and acute care claims.ResultsClaims were analyzed for 4772 youths (mean [SD] age, 13.6 [3.7] years; 4300 [90.1%] type 1 diabetes; 472 [9.9%] type 2 diabetes; 2465 [51.7%] male; 128 [2.7%] Asian, 303 [6.4] Black or African American, 429 [9.0%] Hispanic or Latino, 3366 [70.5%] non-Hispanic White, and 546 [11.4%] unknown race and ethnicity). Specialist claims were lower in type 2 compared with type 1 diabetes (incidence rate ratio [IRR], 0.61 [95% CI, 0.52-0.72]; P &lt; .001) in propensity score–weighted analyses. The presence of a comorbidity was associated with increased specialist claims for type 1 diabetes (IRR, 1.07 [95% CI, 1.03-1.10]) and decreased claims for type 2 diabetes (IRR, 0.77 [95% CI, 0.67-0.87]). Pooling diagnosis groups and adjusted for covariates, each additional specialist claim was associated with increased odds of a claim with a diabetes care and education specialist (odds ratio [OR], 1.31 [95% CI, 1.25-1.36]), dietitian (OR, 1.14 [95% CI, 1.09-1.19]), and behavioral health clinician (OR, 1.16 [95% CI, 1.12-1.20]). For acute care claims, each additional specialist claim was associated with increased odds of admission (OR, 1.17 [95% CI, 1.11-1.24]) but not for emergency claims (OR, 1.03 [95% CI, 0.98-1.82]).Conclusions and RelevanceThis cross-sectional study found that youths with type 2 diabetes were significantly less likely to have specialist claims despite insurance coverage, indicating other barriers to care, which may include medical complexity. Access to diabetes specialists influences engagement with multidisciplinary services. The association between increasing ambulatory clinician services and admissions suggests high utilization by a subgroup of patients at greater risk for poor outcomes.

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Section: Discussionmentioning

confidence: 99%

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes

March,

Byerly,

Siminerio

et al. 2024

JAMA Netw Open

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“…While maintaining a stable A1c at less than 7% is the goal, this target is not consistently achieved. The mean A1c across pediatric centers in the United States is 9.1% for youth with T1D and 9.6% for youth with T2D (The TODAY Study Group, 2020, Urbina et al, 2019). A study of registry data from over 500 youth with T2D 4 years after diagnosis identified that more than 50% of youth with T2D have A1c values over 9% (Nambam et al, 2017).…”

Section: The Impact Of Health Inequities and Disparities On Diabetes ...mentioning

confidence: 99%

Implementing an integrated psychology, social services, and pediatric diabetes clinic.

Totka¹,

Smith²,

Brown³

et al. 2023

Clinical Practice in Pediatric Psychology

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Objective: Integrated behavioral health services are rarely implemented as a shared space practice in pediatric diabetes specialty clinics. This paper outlines the clinical outcomes, lessons learned, facilitators, and barriers for supporting youth with diabetes and behavioral health issues whose hemoglobin A1c (A1c) was higher than the target range and their families. Methods: Using the Iowa Model of implementation, we redesigned the "Regular Engagement And Connection for Health" (REACH) program to integrate health psychology and social services in a shared space clinic for monthly or bimonthly diabetes visits (REACH+). This clinic focused on partnering with families, screening for behavioral and social determinants of health (SDOH), and identifying goals to provide holistic care. This paper presents program evaluation data from the first 50 youth-parent dyads. Results: A team in which all roles were respected and valued was critical to successfully implementing REACH+. Youth in the REACH+ clinic decreased their A1c, emergency room visits, and hospitalizations. Forty percent of youth returned to the standard diabetes clinic. Parents reported fewer resource needs associated with SDOH. Conclusions: A structured implementation process for the planning, delivery, and evaluation of a fully integrated shared space pediatric diabetes clinic promoted team cohesion, consensus, and ongoing administrative support along with positive patient and family outcomes. Implications for Impact StatementUsing an implementation process to build a shared space healthcare team, including psychology and social services, was key to supporting patient and family health outcomes for youth with diabetes. Outcomes included improved A1c, and fewer emergency health and resource needs. Forty percent of youth returned to standard diabetes care.

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“…Many EAWD do not achieve target HbA1c, and engagement in self-care behaviors has been observed to be less than optimal. [4][5][6] For emerging adults with type 1 diabetes, HbA1c may peak in late adolescence with increasing, though not optimal, control through emerging adulthood. 5 For emerging adults with type 2 diabetes, HbA1c may increase over emerging adulthood.…”

Section: Emerging Adulthood and Diabetes Care Challengesmentioning

confidence: 99%

“…5 For emerging adults with type 2 diabetes, HbA1c may increase over emerging adulthood. 6 Poor psychosocial outcomes such as diabetes-related distress are higher among EAWD compared to other adults with diabetes. Younger adults (21-44 years) with type 2 diabetes are less likely to engage in follow-up care compared to older adults, and emerging adults with type 1 diabetes are less likely to engage in follow-up after transitioning to adult care.…”

Section: Emerging Adulthood and Diabetes Care Challengesmentioning

confidence: 99%

Emerging Adults with Diabetes in Safety-Net Care: Self-Management Influences and Patient-Provider Interactions

et al. 2023

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Emerging adults with diabetes, particularly in underserved communities, represent a growing but less studied population whose needs may differ from older adults. This study investigated perspectives of underserved emerging adults regarding diabetes self-management influences and provider interactions. Focus groups and interviews with emerging adults in a safety-net health care setting were conducted to identify perspectives regarding self-management influences and patient-provider interactions. Diabetes was perceived as a psychological burden complicated by busy lifestyles and competing responsibilities. Lack of resources, especially financial barriers, also limited self-management. Participants often perceived diabetes visits as standardized encounters providing access to diabetes supplies but desired additional guidance appropriate to their needs and life-stage. Participants valued encouragement and positive ongoing provider relationships for tailored informational and emotional support and support from family and peers. Providers and health care systems adapting to provide or facilitate this support will be better able to optimize diabetes management at and between visits.

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Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study

Cited by 14 publications

References 28 publications

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes

Implementing an integrated psychology, social services, and pediatric diabetes clinic.

Emerging Adults with Diabetes in Safety-Net Care: Self-Management Influences and Patient-Provider Interactions

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