Physician utilization by insurance type among youth with type 2 diabetes

To evaluate the relationship between insurance type (Medicaid vs private insurance) and access to physician care for youth with type 2 diabetes mellitus by quantifying whether these youth saw a physician during the year before their first diabetes documentation.

Retrospective cohort study.

Youth with Medicaid or private insurance aged 5 to 19 years with type 2 diabetes were identified by an electronic medical record review. The first indication of type 2 diabetes defined the index date. Youth with type 1 diabetes and female patients with polycystic ovaries were excluded. Descriptive statistics evaluated differences in office visits before the index date between patients with the 2 insurance types. Multivariate logistic regression analysis evaluated the likelihood of having an office visit during the year before the index date among youth with Medicaid versus private insurance, controlling for youth characteristics.

Of 2496 included youth, 400 (16.0%) had Medicaid coverage. More than 60% were female, the mean age was 14.5 years, and 68.8% were obese. On average, youth had 1.9 office visits during the year before the index date. Medicaid-covered youth were not significantly less likely to have had an office visit (odds ratio, 0.77; P = .09) or fewer total office visits (incident rate ratio, 1.13; P = .16) during the year before the index date.

The likelihood of youth with type 2 diabetes and a source of physician care having a physician office visit during the year before the index date did not differ between patients with Medicaid versus private insurance. This suggests that the amount of physician care before diagnosis of type 2 diabetes does not differ for Medicaid-covered youth if they can establish a source of care. Additional research is investigating whether physician access before diagnosis is associated with access to diabetes-related care after diagnosis.