Factors associated with higher hemoglobin A1c and type 2 diabetes-related costs: Secondary data analysis of adults 18 to 64 in Texas with commercial insurance

Marcia G Ory; Gang Han; Sagar N Jani; Lixian Zhong; Elena Andreyeva; Keri Carpenter; Samuel D Towne Jr; Veronica Averhart Preston; Matthew Lee Smith

doi:10.1371/journal.pone.0289491

Factors associated with higher hemoglobin A1c and type 2 diabetes-related costs: Secondary data analysis of adults 18 to 64 in Texas with commercial insurance

PLoS One. 2023 Sep 8;18(9):e0289491. doi: 10.1371/journal.pone.0289491. eCollection 2023.

Authors

Marcia G Ory^{1

2}, Gang Han^{1

3}, Sagar N Jani¹, Lixian Zhong^{1

4}, Elena Andreyeva^{1

5}, Keri Carpenter¹, Samuel D Towne Jr^{1

2

6

7

8}, Veronica Averhart Preston⁹, Matthew Lee Smith^{1

2}

Affiliations

¹ Center for Community Health and Aging, Texas A&M University, College Station, Texas, United States of America.
² Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, Texas, United States of America.
³ Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas, United States of America.
⁴ College of Pharmacy, Texas A&M University, College Station, Texas, United States of America.
⁵ Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas, United States of America.
⁶ School of Global Health Management and Informatics, University of Central Florida, Orlando, Florida, United States of America.
⁷ Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, Florida, United States of America.
⁸ Southwest Rural Health Research Center, Texas A&M University, College Station, Texas, United States of America.
⁹ Blue Cross Blue Shield of Texas, a subsidiary of Health Care Service Corporation, Richardson, Texas, United States of America.

Abstract

Objective: This study will identify factors associated with higher hemoglobin A1c (A1c) values and diabetes-related costs among commercially insured adults in Texas diagnosed with type 2 diabetes.

Research design and methods: This secondary data analysis was based on claims data from commercially insured individuals 18-64 years of age residing in Texas with diagnosed type 2 diabetes during the 2018-2019 study period. The final analysis sample after all the exclusions consisted of 34,992 individuals. Measures included hemoglobin A1c, diabetes-related costs, Charlson Comorbidity Index, diabetes-related complications, rurality and other socioeconomic characteristics. Longitudinal A1c measurements were modeled using age, sex, rurality, comorbidity, and diabetes-related complications in generalized linear longitudinal regression models adjusting the observation time, which was one of the 8 quarters in 2018 and 2019. The diabetes-related costs were similarly modeled in both univariable and multivariable generalized linear longitudinal regression models adjusting the observation time by calendar quarters and covariates.

Results: The median A1c value was 7, and the median quarterly diabetes-related cost was $120. A positive statistically significant relationship (p = < .0001) was found between A1c levels and diabetes-related costs, although this trend slowed down as A1c levels exceeded 8.0%. Higher A1c values were associated with being male, having diabetes-related complications, and living in rural areas. Higher costs were associated with higher A1c values, older age, and higher Charlson Comorbidity Index scores.

Conclusion: The study adds updated analyses of the interrelationships among demographic and geographic factors, clinical indicators, and health-related costs, reinforcing the role of higher A1c values and complications as diabetes-related cost drivers.

Copyright: © 2023 Ory et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Diabetes Mellitus, Type 2* / epidemiology
Female
Glycated Hemoglobin
Humans
Insurance*
Male
Secondary Data Analysis
Texas / epidemiology

Substances

Glycated Hemoglobin

Grants and funding

“This research was supported by a grant from Blue Cross Blue Shield of Texas (Grant number 23-468611) to establish a Rural Health Moonshot Program at Texas A&M Health Science Center. The PIs on this project are MGO and MLS. See https://www.bcbstx.com/company-info/community-involvement/apply-for-funding. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study. The funder provided support in the form of salaries for VAP, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.”.