Health insurance status and type associated with varying levels of glycemic control in the US: The multi-ethnic study of atherosclerosis (MESA).

Abstract

AIMS:

To investigate associations of health insurance with measures of glucose metabolism, and whether associations vary by diabetes status or insurance type.

METHODS:

Cross-sectional analysis of baseline data from the Multi-Ethnic Study of Atherosclerosis. Cohort a priori stratified by age <65 (N = 3,665) and ≥65 years (N = 2,924). Multivariable linear and logistic regression assessed associations between insurance and fasting glucose, HOMA-IR, and prevalent diabetes, controlling for relevant confounders, including age, sex, race/ethnicity, income, and education.

RESULTS:

In participants <65, compared to uninsured, having any insurance was associated with lower fasting glucose in participants with diabetes (Mean Difference = -20.4 mg/dL, P = 0.01), but not in participants without diabetes. Compared to Private insurance, uninsured participants had higher fasting glucose (Mean Difference = 3.8 mg/dL, P = 0.03), while participants with Medicaid had higher HOMA-IR (Mean Difference = 3.5 mg/dL, P < 0.01). In participants ≥65, compared to Private insurance, uninsured participants (Mean Difference = 7.5 mg/dL, P = 0.02), and participants with Medicaid only (Mean Difference = 19.9 mg/dL, P < 0.01) or Medicare + Medicaid (Mean Difference = 5.2 mg/dL, P = 0.03) had higher fasting glucose.

CONCLUSIONS:

In this large multiethnic cohort, having any insurance was associated with significantly lower fasting glucose for individuals with diabetes. Levels of fasting glucose and insulin resistance varied across different insurance types.

• Authors: Rebecca S Gold, Jonathan T Unkart, Robyn L McClelland, Alain G Bertoni, Matthew A Allison
• Journal: Primary care diabetes (Prim Care Diabetes) Vol. 15 Issue 2 Pg. 378-384 (04 2021) ISSN: 1878-0210 [Electronic] England
• PMID: 33309035 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: Copyright © 2020 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Blood Glucose

Topics

• Aged
• Atherosclerosis (diagnosis)
• Blood Glucose
• Cross-Sectional Studies
• Diabetes Mellitus, Type 2
• Ethnicity
• Glycemic Control
• Humans
• Insurance, Health
• Medicare
• United States (epidemiology)