Health Insurance and the Development of Diabetic Complications

Flavin, Nina E.; Mulla, Zuber D.; Bonilla-Navarrete, Aracely; Lopez, Oscar; Tovar, Yara E.; Meza, Armando

doi:10.1097/smj.0b013e3181aa5f5b

Cited by 12 publications

(9 citation statements)

References 10 publications

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“…Patients with diabetes having health insurance are more likely to have better glycemic control and lower rates of diabetic eye disease compared to those lacking health insurance. 16,49,50 Given the lower DR rate in the pharmacy cohort, it may be that screening in this setting will have lower yield than in outpatient clinics, an issue for further study.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Eye Screening in Urban Settings Serving Minority Populations

et al. 2015

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The use of a nonmydriatic camera for retinal imaging combined with the remote evaluation of images at a telemedicine reading center has been advanced as a strategy for diabetic retinopathy (DR) screening, particularly among patients with diabetes mellitus from ethnic/racial minority populations with low utilization of eye care.OBJECTIVE To examine the rate and types of DR identified through a telemedicine screening program using a nonmydriatic camera, as well as the rate of other ocular findings. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study (Innovative Network for Sight [INSIGHT]) was conducted at 4 urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority and uninsured persons with diabetes. Participants included persons aged 18 years or older who had type 1 or 2 diabetes mellitus and presented to the community-based settings. MAIN OUTCOMES AND MEASURESThe percentage of DR detection, including type of DR, and the percentage of detection of other ocular findings.RESULTS A total of 1894 persons participated in the INSIGHT screening program across sites, with 21.7% having DR in at least 1 eye. The most common type of DR was background DR, which was present in 94.1% of all participants with DR. Almost half (44.2%) of the sample screened had ocular findings other than DR; 30.7% of the other ocular findings were cataract.CONCLUSIONS AND RELEVANCE In a DR telemedicine screening program in urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority populations, DR was identified on screening in approximately 1 in 5 persons with diabetes. The vast majority of DR was background, indicating high public health potential for intervention in the earliest phases of DR when treatment can prevent vision loss. Other ocular conditions were detected at a high rate, a collateral benefit of DR screening programs that may be underappreciated.

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Section: Discussionmentioning

confidence: 99%

Diabetes Eye Screening in Urban Settings Serving Minority Populations

et al. 2015

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“… 19 , 20 , 21 Indeed, patients with no health insurance or who are underinsured are more likely to experience diabetes-related complications and lower extremity amputations. 7 , 22 , 23 …”

Section: Discussionmentioning

confidence: 99%

Rates of Diabetes-Related Major Amputations Among Racial and Ethnic Minority Adults Following Medicaid Expansion Under the Patient Protection and Affordable Care Act

et al. 2022

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Key Points Question Has the amputation rate among African American, Hispanic, and other racial and ethnic minority adults with diabetic foot ulcerations (DFUs) changed during the early implementation of the Patient Protection and Affordable Care Act (ACA)? Findings In a cohort study of 115 071 hospitalizations for DFUs among racial and ethnic minority adults, early Medicaid expansion was associated with decreased major amputation and hospitalization rates in early-adoption states compared with nonadoption states. Meaning These findings suggest that early ACA implementation was associated with decreased lower extremity amputation among underserved racial and ethnic minority adults with DFUs.

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“…The discrepancy in LEA prevalence by geo- graphic area may also be partly attributable to regional differences in care and treatment. According to previous research with Medicare patients (35)(36)(37), the procedures for many types of surgery, including LEA in persons with diabetes, vary highly across geographic areas. A study at a teaching hospital in the Texas border area found that people with diabetes who had no insurance were twice as likely to suffer from limb amputations as those with some form of insurance (37).…”

Section: Discussionmentioning

confidence: 99%

“…According to previous research with Medicare patients (35)(36)(37), the procedures for many types of surgery, including LEA in persons with diabetes, vary highly across geographic areas. A study at a teaching hospital in the Texas border area found that people with diabetes who had no insurance were twice as likely to suffer from limb amputations as those with some form of insurance (37). These findings suggest that geographic variations in LEA prevalence may be explained by differences in population characteristics, insurance benefits, surgery capacity, and care and treatment styles.…”

Section: Discussionmentioning

confidence: 99%

Ethnic and health correlates of diabetes-related amputations at the Texas-Mexico border

Mier¹,

Ory²,

Zhan³

et al. 2010

Rev Panam Salud Publica

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Objective. To examine the association between diabetes-related lower-extremity amputation (LEA) and ethnicity, age, source of payment, geographic location, diabetes severity, and health condition in adults with diabetes mellitus type 2 living in border and non-border counties in Texas, United States of America, and to assess intra-border region geographic differences in post-LEA treatment. Methods. This correlational study was based on secondary data from the 2003 Texas Inpatient Hospital Discharge Data. The sample consisted of individuals 45 years of age and older with type 2 diabetes who had undergone a nontraumatic LEA (n = 5 865). Descriptive statistics and logistic regression analyses were applied. Results. The following characteristics were predictors of LEA: being Hispanic or African American, male, ≥ 55 years old, and a Medicare or Medicaid user, and living in a border county. Persons with moderate diabetes and those who suffered from cardiovascular disease or stroke also had higher odds of undergoing an LEA. Post-LEA occupational therapy was significantly less prevalent among border residents (9.5%) than non-border residents (15.3%) (P < 0.001). Conclusion. Understanding the factors that influence diabetes-related LEA may lead to early detection and effective treatment of this disabling consequence of diabetes along the U.S.-Mexico border. Amputation; border health; diabetes mellitus, type 2; minority health; Mexico; Texas; United States.

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Health Insurance and the Development of Diabetic Complications

Abstract: Not having health insurance was a risk factor for developing diabetic complications in a group of predominantly Hispanic patients.

Cited by 12 publications

References 10 publications

Diabetes Eye Screening in Urban Settings Serving Minority Populations

Diabetes Eye Screening in Urban Settings Serving Minority Populations

Rates of Diabetes-Related Major Amputations Among Racial and Ethnic Minority Adults Following Medicaid Expansion Under the Patient Protection and Affordable Care Act

Ethnic and health correlates of diabetes-related amputations at the Texas-Mexico border

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