HbA1c Monitoring among Adolescents and Young Adults with Type 1 Diabetes: Impact of Diabetes Care Provider Type

Adolescents and young adults with type 1 diabetes (T1D) are at-risk of not receiving the recommended levels of annual HbA1c testing, but extent to which this occurs and the degree to which this may due to not accessing care or changes in physicians is poorly understood. This is an observational study of 9,916 unique 13-26 year olds with T1D who were continuously insured by a large US health insurer for 12 months or more during 2012-2016. We evaluate the frequency at which this population does not receive twice yearly HbA1c tests and the degree to which such rates are associated with age, not accessing care at all, and types of physicians of delivering diabetes care descriptively and using multivariable regression. The percent of those with T1D not receiving twice yearly HbA1c tests rose from 17% to 40% between the ages of 13 to 26 (peaked at 45% at age 24). The percent not making any diabetes visit within a year rose from 12% to 17% between those same ages. Pediatric endocrinologists and general pediatricians were the dominant providers at age 13 (62% and 26%, respectively), while adult endocrinologists and adult primary care physicians were the dominant providers at age 26 (48% and 44%, respectively). The age at which care transfers from pediatric to adult physicians appears to be at age 18 for primary care and at age 19 for endocrinologists. Receiving the twice yearly HbA1c tests was associated with endocrinologists after adjusting for sex, age, rurality, and neighborhood poverty. HbA1c monitoring declines substantially as adolescents grow into adults and appears to be related to not accessing healthcare despite being insured and also be due to transferring from pediatric to adult primary care physicians and endocrinologists. Disclosure L. E. Wisk: None. M. Landrum: None. C. Fu: None. A. Chien: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K01DK116932 to L.E.W.); Agency for Healthcare Research and Quality (U19HS024072 to A.C.)