Young adults' lack of regular diabetes care may be linked to beliefs about medication
Follow-up research from the TODAY study found that a quarter of participants, ages 19 to 31 years, lacked a usual place for diabetes care and almost half had an urgent care visit in the past year. Belief in the necessity of medications was associated with regular access to care.
Suboptimal health care usage, common in patients with youth-onset type 2 diabetes, may be related to beliefs about medications and self-management, among other factors, a study found.
To identify psychosocial predictors of health care use, researchers used longitudinal data on 366 patients ages 19 to 31 years from follow-up of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) cohort study. The authors defined suboptimal health care use as no usual place for diabetes care (diabetes home), no visits for routine care, or one or more urgent care visit in the past six months. The researchers surveyed the participants on their health care use, diabetes self-efficacy, symptoms of depression and anxiety, diabetes distress, beliefs about medicines, diabetes attitudes, material need insecurities, and self-management support. Results were published July 28 by the Journal of General Internal Medicine.
The participants' mean age was 26 years and the mean HbA1c level was 9.4%. A quarter (25.4%) had no diabetes home, 23.7% had no routine care visits, and 46% had one or more urgent care visit in the past six months. Higher odds of having a diabetes home were predicted by belief in the necessity of diabetes medications (adjusted odds ratio [OR], 1.28 [95% CI, 1.12 to 1.46]; P<0.001), concerns about medications (OR, 1.29 [95% CI, 1.08 to 1.54]; P=0.004), and belief about diabetes' negative psychosocial impacts (OR, 1.57 [95% CI, 1.04 to 2.38]; P=0.03). Belief that medicines are harmful predicted lower odds of a diabetes home (OR, 0.56 [95% CI, 0.37 to 0.85]; P=0.006). Belief that medications are necessary (OR, 1.2 [95% CI, 1.06 to 1.36]; P=0.004) and presence of self-management support (OR, 1.5 [95% CI, 1.08 to 2.07]; P=0.01) were associated with having one or more diabetes care visits in a year, while belief in medication harms was inversely associated (OR, 0.6 [95% CI, 0.41 to 0.88]; P=0.01).
The study authors noted that establishing consistent care is especially important for this population, as a majority of youth in the TODAY study required insulin within two years of diagnosis. “Given poor outcomes and high rates of early complications in young adults with youth-onset [type 2 diabetes], we must identify and overcome barriers to establishing stable diabetes care as a foundation supporting healthier physical, behavioral and emotional health,” they wrote.