Association between status of medical insurance and self-management compliance, metabolic control in patients with type 2 diabetes mellitus

Abstract

Objective To investigate the impact of status of medical insurance on self-management compliance and metabolic control in patients with type 2 diabetes mellitus (T2DM) in China. Methods This was an observational cross-sectional study including 5 852 patients with T2DM across 50 representative centers in China. Among these patients, 4 824 patients were covered by medical insurance (medical insurance group, MI group) whereas 1 028 patients were not (self-payment group, SP group). The data of demographics, medical history, metabolic parameters, diabetes related costs and self-management obedience were collected by questionnaire survey. A total of 1 281 subjects were included in the analysis which were 1∶2 propensity score matched by sex, smoking, body mass index (BMI), smoking, diabetes duration, education level and age. One-way ANOVA and Chi-squared test were used to test the differences between the two groups. Pearson correlation analysis was applied in correlation test. Results (1)The average coverage of medical insurance was 82.43% in this population. Patients in MI group had lower levels of glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), 2 hours postprandial plasma glucose (2hPG), triglycerides (TG) and total cholesterol (TC) than patients in SP group [HbA1c (8.6±2.4)% vs (9.0±2.4)%; FPG (8±3) vs (9±4) mmol/L;2hPG (12±5) vs (13±5) mmol/L; TG (2.0±1.6) vs (2.3±2.1) mmol/L; TC(4.8±1.4) vs (5.0±1.5) mmol/L, F=4.229-21.620, all P 0.05). Patients in MI group had higher costs related to diabetes [5 000 (3 000, 10 000) vs 4 500(2 415, 8 000) RMB, P<0.05] and higher compliance of self-management including diabetes education (81.26% vs 71.20%), reexamination (55.85% vs 45.67%), exercise (37.35% vs 29.27%), drug program (70.84% vs 58.54%), self-monitoring (24.82% vs 20.37%) and doctor visits (26.81% vs 18.74%) (χ2=2.906-18.838, all P<0.05 except the self-monitoring, P=0.088). Pearson correlation analysis revealed that MI had a positive correlation with diabetes self-management obedience (correlation indexes were 0.114, 0.096, 0.115, 0.109, 0.077, respectively). Conclusions There are 17.57% patients with T2DM not covered by medical insurance in this survey. Lacking of medical insurance may be associated with lower medical expenditure and self-management compliance, and consequently may lead to poorer metabolic control. These results suggest that the coverage of medical insurance for T2DM patients might play a potential role in the improvement of metabolic control. Key words: Diabetes mellitus, type 2; Medicare; Diabetic complications; Self-management