Discussion
T2D, youth-onset T2D, T1D, diabetes complications, HbAAccess, T2D diabetes, diabetes
DIABETES
In this cohort study, patterns of health care coverage, access to, and use of diabetes care differed between the T1D and T2D groups. Participants with T2D were more likely to report having no health care coverage, less likely to have an established source of diabetes care, and reported a lower frequency of use of diabetes care compared with those with T1D. Reported OOPEs were markedly higher in participants with T1D compared with those with T2D, which was likely associated with higher costs of care, including insulin, insulin pumps, and frequent fingerstick or continuous glucose monitoring among participants with T1D, although this finding may also reflect participants with T2D who were not filling prescriptions or seeking care. Lack of health care coverage and lack of an established source of diabetes care were associated with higher HbAAccess to diabetes care is an important issue for all younger adults with diabetes, and this study identified areas of limited access among both T1D and T2D populations. However, less access (ie, no health care coverage and no usual source of diabetes care) was more frequently reported by participants with T2D in both SEARCH and TODAY studies. Economic and social determinants of health likely play a key role here. The sociodemographic characteristics of sex, race and ethnicity, educational level, and household income of participants with T1D were different from those of participants with T2D. Less access to and use of diabetes care in those with T2D was especially alarming given emerging evidence that T2D diagnosed in youth follows a more aggressive clinical course and that youth and young adults with T2D have a higher frequency of diabetes complications than those with T1D of similar duration.The reasons for not having an established source of diabetes care varied by diabetes type. Participants with T1D reported having no coverage, changing insurance plans, and high costs as reasons for having no source of diabetes care. For participants with T2D, the commonly cited reasons were having no coverage, not feeling a need for care, and not knowing where to get care. The finding that many participants with T2D believed they did not need diabetes care because they were never or rarely sick suggests a need for dramatically more effective education regarding the potential implication of youth-onset T2D for health outcomes, especially given the high mean HbAHealth care coverage availability has been a policy issue in the US for decades. In this study, participants with T1D or T2D diabetes residing in states with expanded Medicaid programs reported higher frequencies of health care coverage and lower mean HbAThe association of lack of health care coverage and lack of usual source of diabetes care with higher HbAThese study results involve patterns that existed before the COVID-19 pandemic. The long-term implication of the pandemic for health care access and diabetes care in younger adults with diabetes is yet to be determined. An increase in non–employer-sponsored health care coverage, such as Medicaid expansion, and stability in employer-sponsored health care coverage were observed in 2021 to early 2022,