Abstract P162: Different Types of Health Insurance are Associated With Varying Levels of Glycemic Control and Insulin Resistance: The Multi-ethnic Study of Atherosclerosis (MESA)
Introduction: Health insurance may influence patient access and care, and thereby glycemic control. In this study, we assessed associations of insurance status with measures of glucose regulation and whether these associations varied by different insurance types, diabetes status, and/or diabetes medication use. Methods: We used baseline data (2000-2002) from the Multi-Ethnic Study of Atherosclerosis ( N = 6,627), a cohort study of adults from four racial/ethnic groups without clinically apparent cardiovascular disease. Using multivariable linear regression to adjust for confounders (age, race, sex, study site, usual site of medical care, alcohol and tobacco use, education, income, dyslipidemia, hypertension, BMI), we measured associations of insurance status and insurance type with fasting glucose and homeostasis model assessment of insulin resistance (HOMA-IR). Results: Approximately 50% of the cohort were female and the mean age and BMI were 62y and 28 kg/m 2 , respectively. Overall, 598 (9%) participants were uninsured, while 6,029 (3,343-Private, 830-Medicare, 104- Medicaid, 77-Military, 1,675-Multiple) had insurance. Fourteen percent of the total cohort had diabetes. The proportion of undiagnosed diabetes was higher in uninsured (5%) compared with insured (3%). Compared to the uninsured, insured participants had significantly lower fasting glucose (Table 1). This association persisted only among participants with diabetes. Private, Medicare, and Multiple insurance types were associated with lower fasting glucose, and only among participants with diabetes. Notably, Medicaid was associated with higher HOMA-IR. Conclusion: In this large multiethnic cohort, health insurance was associated with significantly lower fasting glucose. These findings demonstrate insurance coverage is relevant towards improving glycemic control in patients with diabetes. However, our study also highlights nuances and limitations to this relationship, suggesting that all types of insurance may not be equivalent.