Transportation Barriers and Diabetes Outcomes: A Longitudinal Analysis

Area of Science:

• Diabetes Management
• Public Health
• Health Disparities

Background:

• Transportation barriers present a significant challenge for individuals managing chronic conditions like type 2 diabetes mellitus.
• Access to healthcare services and consistent medical monitoring are vital for effective diabetes care.

Purpose of the Study:

• To investigate the association between experiencing transportation barriers and key diabetes health indicators.
• To quantify the impact of transportation barriers on hemoglobin A1c (HbA1c), blood pressure (BP), and LDL cholesterol levels over time.

Main Methods:

• A longitudinal cohort study involving 86,977 adults with type 2 diabetes was conducted.
• Participants' transportation barriers were assessed, and outcomes including HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP), and LDL cholesterol were tracked for up to 36 months.
• Targeted minimum loss estimation was employed to compare outcomes between individuals with and without transportation barriers at multiple time points.

Main Results:

• Absence of transportation barriers was associated with a statistically significant reduction in mean HbA1c by 0.09% at 12 months (P=.0002).
• Lower systolic blood pressure (-0.6 mm Hg) and diastolic blood pressure (-0.3 mm Hg) were also observed in individuals without transportation barriers at 12 months (P=.004 and P=.02, respectively).
• No significant association was found between transportation barriers and LDL cholesterol levels.

Conclusions:

• While removing transportation barriers shows a modest positive effect on HbA1c and blood pressure, the impact is relatively small.
• Addressing transportation barriers alone may not be sufficient for substantial improvements in diabetes outcomes; integrated approaches considering other contributing factors are necessary.