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- Title
Disparities in Hemoglobin A<sub>1c</sub> Testing During the Transition to Adulthood and Association With Diabetes Outcomes in Youth-Onset Type 1 and Type 2 Diabetes: The SEARCH for Diabetes in Youth Study.
- Authors
Sauder, Katherine A.; Stafford, Jeanette M.; Ehrlich, Shelley; Lawrence, Jean M.; Liese, Angela D.; Marcovina, Santica; Mottl, Amy K.; Pihoker, Catherine; Saydah, Sharon; Shah, Amy S.; D'Agostino Jr., Ralph B.; Dabelea, Dana; D'Agostino, Ralph B Jr; SEARCH for Diabetes in Youth Study Group
- Abstract
<bold>Objective: </bold>To identify correlates of hemoglobin A1c (HbA1c) testing frequency and associations with HbA1c levels and microvascular complications in youth-onset diabetes.<bold>Research Design and Methods: </bold>The SEARCH for Diabetes in Youth study collected data from individuals diagnosed with diabetes before age 20 at 8 years (n=1,885 type 1, n=230 type 2) and 13 years (n=649 type 1, n = 84 type 2) diabetes duration. We identified correlates of reporting ≥3 HbA1c tests/year using logistic regression. We examined associations of HbA1c testing with HbA1c levels and microvascular complications (retinopathy, neuropathy, or nephropathy) using sequentially adjusted linear and logistic regression.<bold>Results: </bold>For type 1 diabetes, odds of reporting ≥3 HbA1c tests/year at 8 and 13 years diabetes duration decreased with older age at diagnosis (odds ratio [OR] 0.91 [95% CI 0.88-0.95]), longer duration of diabetes (OR 0.90 [0.82-0.99]), not having a personal doctor (OR 0.44 [0.30-0.65]), and lapses in health insurance (OR 0.51 [0.27-0.96]). HbA1c testing ≥3 times/year over time was associated with lower HbA1c levels (OR -0.36% [-0.65 to -0.06]) and lower odds of microvascular complications (OR 0.64 [0.43-0.97]) at 13 years duration, but associations were attenuated after adjustment for HbA1c testing correlates (OR -0.17 [-0.46 to 0.13] and 0.70 [0.46-1.07], respectively). For type 2 diabetes, not seeing an endocrinologist decreased the odds of reporting ≥3 HbA1c tests/year over time (OR 0.19 [0.06-0.63]), but HbA1c testing frequency was not associated with HbA1c levels or microvascular complications.<bold>Conclusions: </bold>We observed disparities in HbA1c testing frequency predominately by health care-related factors, which were associated with diabetes outcomes in type 1 diabetes.
- Publication
Diabetes Care, 2021, Vol 44, Issue 10, p2320
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc20-2983