Insurance coverage and diabetes quality indicators among patients with diabetes in the US general population

This study explores associations between health insurance and diabetes quality indicators. Data were obtained from 8305 patients with diabetes who reported no insurance, Medicaid or private insurance in the 2013 BRFSS in 26 states in the US. Six diabetes quality indicators were assessed: HgbA1c testing, foot exam, eye exam, influenza immunization, pneumococcal immunization and diabetes education. Logistic regression was performed comparing quality indicators by insurance group adjusting for covariates. Subjects with private insurance or Medicaid were more likely than the uninsured to have HgbA1c testing (OR=2.60, 95%CI: 2.02-3.35; OR=2.04, 95%CI: 1.55-2.69, respectively), a foot exam (OR=1.72, 95%CI: 1.32-2.25; OR=1.64, 95%CI: 1.23-2.18, respectively) and an eye exam (OR=2.01, 95%CI: 1.56-2.58; OR=2.50, 95%CI: 1.91-3.27, respectively). Those with private insurance were more likely than the uninsured to have influenza immunization (OR=1.75, 95%CI: 1.37-2.25) and diabetes education (OR=1.36, 95%CI: 1.06-1.74). Uninsured persons with diabetes are less likely to receive standard diabetes services compared to the insured, but most quality indicators were similar in publicly and privately insured groups.