title: The impact of health insurance coverage on pediatric diabetes management.
abstract: OBJECTIVE
  To examine the association between health insurance coverage, insulin management plans, and their impact on diabetes control in a pediatric type 1 diabetes mellitus clinic population.
  
  
  METHODS
  Retrospective cohort design drawn from the medical records of the Pediatric Endocrinology Clinic at the University of Louisville, Kentucky.
  
  
  RESULTS
  Out of 701 patients, 223 had public insurance, and 478 had private insurance. 77% of publically insured used two or three injections per day vs. 40% private. Conversely, 58% of privately insured used a multiple daily injection (MDI) plan or insulin pump (vs. 21%). 84% of MDI patients had private insurance with 93% using insulin pens compared with 38% of publically insured. Mean HbA1c was 8.6% for privately insured vs. 9.8% public, p<0.0001. Privately insured MDI and pump patients had the lowest HbA1cs.
  
  
  CONCLUSIONS
  Insurance type had a significant effect on the insulin management plan used and was the most significant factor in overall diabetes control. Limitations on insulin pen use and number of glucose test strips may play a role in the decreased use of MDI/insulin pumps by publicly insured patients. Addressing factors related to insurance type, including availability of resources, could substantially improve diabetes control in those with public insurance.
authors.affiliation: Department of Pediatrics, Division of Endocrinology, School of Medicine, University of Louisville, Louisville, KY 40202, USA. kawint01@louisville.edu
authors.forename: Kupper A
authors.initials: KA
authors.lastname: Wintergerst
authors.forename: Krystal M
authors.initials: KM
authors.lastname: Hinkle
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Barnes
authors.forename: Adetokunbo O
authors.initials: AO
authors.lastname: Omoruyi
authors.forename: Michael B
authors.initials: MB
authors.lastname: Foster
mesh_terms: D000293:Adolescent; D015190:Blood Glucose Self-Monitoring / Q000191:economics; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006785:Hospitals, University; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D007332:Insulin Infusion Systems / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health; D008297:Male; D008499:Medical Records; D009310:National Health Insurance, United States; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human