title: The impact of insurance coverage and the family on pediatric diabetes management.
abstract: The impact of family composition on glycemic control in children with type 1 diabetes remains unclear. We sought to evaluate the relationship between health insurance coverage, family composition, and insulin management, and assess their impact on glycemic control in a pediatric type 1 diabetes population.
  
  
  
  A retrospective chart review was completed for patients seen in the Pediatric Endocrinology Clinic at the University of Louisville in 2012.
  
  
  
  The analysis included 729 patients with type 1 diabetes; 268 (37%) had public insurance while 461(63%) had private insurance. Compared with publicly insured patients, privately insured patients had higher rates of intensive insulin management with multiple daily injections (MDI) plans or pump devices (88 vs. 83.2%, p = 0.066) and lower HbA1c levels [8.57 vs. 9.39% (70 vs. 79 mmol/mol), p < 0.001]. Of the 729 patients, 243 were in single-adult homes (33%). Single-adult homes had higher HbA1c levels than two-adult homes, [9.3 vs. 8.6% (78 vs. 70 mmol/mol), p < 0.001]. Among publicly insured, there was no difference in HbA1c levels for single-adult vs. two-adult homes [9.4 (79 mmol/mol), p = 0.868]. For privately insured, patients in single-adult homes had higher HbA1c levels than peers in two-adult homes [9.2 vs. 8.4% (77 vs. 68), p < 0.001].
  
  
  
  Insurance type and family composition have significant associative effects on glycemic control and insulin management that may be mitigated by insulin pump therapy. Identifying and addressing factors such as availability of resources, family education, and adult support and supervision, may help improve glycemic control in high-risk pediatric diabetes patients.
authors.affiliation: Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Watson
authors.affiliation: Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA.
authors.forename: Evan A
authors.initials: EA
authors.lastname: Kuhl
authors.affiliation: Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Foster
authors.affiliation: Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA.
authors.forename: Adetokunbo O
authors.initials: AO
authors.lastname: Omoruyi
authors.affiliation: Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Kingery
authors.affiliation: Department of Pediatrics, Division of Infectious Disease, University of Louisville, Louisville, KY, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Woods
authors.affiliation: Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA.
authors.forename: Kupper A
authors.initials: KA
authors.lastname: Wintergerst
mesh_terms: D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000191:economics; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000191:economics / Q000628:therapy; D004334:Drug Administration Schedule; D005190:Family; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D005102:Health Expenditures; D006785:Hospitals, University; D006801:Humans; D006943:Hyperglycemia / Q000191:economics / Q000517:prevention & control*; 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 / Q000191:economics; D007348:Insurance, Health; D007629:Kentucky; D008297:Male; D010044:Outpatient Clinics, Hospital; D012189:Retrospective Studies; D000073278:Self-Management / Q000191:economics; D015406:Single Parent
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: family; insulin; insurance; type 1 diabetes