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Association Between Health Insurance Type and Adverse Outcomes for Children and Young Adults With Type 1 Diabetes and

Brian Miyazaki1, Osagie Ebekozien2,3, Saketh Rompicherla3

  • 1Children's Hospital Los Angeles, Los Angeles, CA.

Diabetes Spectrum : a Publication of the American Diabetes Association
|November 29, 2023
PubMed

Insights

Publicly insured children and young adults with type 1 diabetes experienced higher rates of severe adverse outcomes, including diabetic ketoacidosis, during acute COVID-19 infections compared to privately insured individuals.

Area of Science:

  • Pediatric Endocrinology
  • Infectious Diseases
  • Health Services Research

Background:

  • Health insurance disparities exist based on socioeconomic status and race in the U.S.
  • Type 1 diabetes management and outcomes can be influenced by insurance type.
  • Acute COVID-19 infections present unique challenges for individuals with chronic conditions like type 1 diabetes.

Purpose of the Study:

  • To compare adverse outcomes in publicly versus privately insured pediatric patients with type 1 diabetes and COVID-19.
  • To identify potential disparities in COVID-19 related complications in young individuals with type 1 diabetes.
  • To assess the impact of insurance coverage on severe outcomes such as diabetic ketoacidosis and hypoglycemia.

Main Methods:

  • Analysis of data from 619 patients under 24 years old with type 1 diabetes and acute COVID-19.
  • Data collected via the T1D Exchange COVID-19 surveillance registry from 52 U.S. endocrinology clinics.
  • Utilized electronic health record data gathered through an online survey tool between April 2020 and December 2021.

Main Results:

  • 257 patients had public insurance and 362 had private insurance.
  • Publicly insured patients reported severe adverse outcomes (diabetic ketoacidosis or severe hypoglycemia) at a rate of 22% (57/257).
  • Privately insured patients reported adverse outcomes at a rate of 7% (25/362).

Conclusions:

  • Publicly insured pediatric patients with type 1 diabetes face higher risks of hospitalization and diabetic ketoacidosis during COVID-19.
  • Racial/ethnic minority children and young adults with type 1 diabetes and public insurance show elevated adverse outcomes.
  • Insurance type is a significant factor in COVID-19 outcomes for young individuals with type 1 diabetes.
Abstract

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