Abstract
BACKGROUND: Glycemic control is essential for reducing complications in individuals with type 2 diabetes. Health insurance is a known determinant of access to care, yet its relationship with glycemic outcomes remains underexplored in nationally representative data. Therefore, the objective of this study is to assess the association between health insurance status and glycemic control among United States (US) adults with diagnosed type 2 diabetes (diagnostic A1c cutoff ≥ 6.5%) using National Health and Nutrition Examination Survey (NHANES) data. We hypothesized that uninsured adults with type 2 diabetes would have higher odds of poor glycemic control. METHODS: A cross-sectional analysis was conducted using data from the NHANES 2013-2018 cycles. Adults aged ≥18 years with diagnosed type 2 diabetes were included. Survey-weighted logistic regression models examined the association between insurance status and poor glycemic control (glycated hemoglobin (HbA1c) ≥ 7%), adjusting for demographic, clinical, and behavioral covariates. Descriptive and inferential statistics accounted for the complex survey design. RESULTS: Among 229 million weighted US adults with diagnosed type 2 diabetes, 195,397,912 (85%) were insured. Among those with poor glycemic control, 18,684,942 (87%) were insured and 2,901,970 (13%) were uninsured. Insurance status was not significantly associated with glycemic control in either the demographically adjusted model (odds ratio (OR) = 1.15, 95% confidence interval (CI): 0.91-1.45) or the fully adjusted model (OR = 1.12, 95% CI: 0.89-1.41). Significant predictors of poor glycemic control included age, gender, body mass index (BMI), income, and race/ethnicity. CONCLUSION: Health insurance alone may not ensure optimal glycemic control. Addressing broader social and clinical factors is essential to improving outcomes in diabetes care.