1078-P: Disparities in HbA1c Testing and Diabetes Outcomes: SEARCH for Diabetes in Youth

Abstract

Hemoglobin A1c (HbA1c) monitoring over time is thought to facilitate care and support diabetes management goals, but only half of youth and young adults with diabetes report ≥3 HbA1c tests/year despite poor glycemic control. We explored disparities in HbA1c testing over time and association with HbA1c levels and microvascular complications (retinopathy, neuropathy, or nephropathy) in the SEARCH for Diabetes in Youth study. Individuals diagnosed with diabetes at <20 years (n=707 type 1, n=112 type 2) did research visits at 8 and 13 years diabetes duration (mean ages 18 and 23 years, respectively). We used one logistic regression model per diabetes type to identify correlates of reporting ≥3 HbA1c tests/year at both visits, and used one multiple linear and one logistic regression model per type to examine associations of reporting ≥3 HbA1c tests/year at both visits with HbA1c levels or microvascular complications, adjusting for HbA1c testing correlates. In type 1 diabetes, odds of reporting ≥3 HbA1c tests/year at both visits decreased with older age at diagnosis (OR 0.91 [95%CI 0.88-0.95]), longer duration of diabetes (OR 0.91 [0.84-0.999]), not having a personal doctor (0.43 [0.30-0.62]), and lapses in health insurance (OR 0.51 [0.28-0.93]). In turn, HbA1c testing ≥3 times/year at both visits was associated with lower HbA1c levels (-0.32% [-0.61 to -0.03]) but not microvascular complications (OR 0.74 [0.49-1.10]) at 13 years duration. In type 2 diabetes, odds of reporting ≥3 HbA1c tests/year at both visits was lower when not receiving care from endocrinologists (OR 0.15 [0.04-0.48]), but not associated with other sociodemographic or clinical factors, and not observed to be associated with HbA1c levels or microvascular complications at 13 years duration. In conclusion, we report that mainly healthcare-related factors are associated with disparities in HbA1c testing frequency over time in youth-onset type 1 and type 2 diabetes, and these disparities are associated with HbA1c levels in type 1 diabetes. Disclosure K. A. Sauder: None. R. Dagostino: Consultant; Self; AstraZeneca, Biogen, Daiichi Sankyo. D. Dabelea: None. J. M. Stafford: None. S. R. Ehrlich: None. A. D. Liese: None. S. M. Marcovina: None. A. K. Mottl: Advisory Panel; Self; Bayer U. S. C. Pihoker: None. S. Saydah: None. A. S. Shah: None. Funding National Institutes of Health; Centers for Disease Control and Prevention