A new study in the Journal of General Internal Medicine revealed troubling comparative trends in the outcomes and daily lives of people with type 1 diabetes in Canada and the United States as they move from adolescence into adulthood. The research showed that once they reach adulthood, young people with type 1 diabetes in the U.S. fare much worse than their Canadian counterparts.
The study, conducted by research teams at Harvard Medical School, Cambridge Health Alliance, the City University of New York at Hunter College, and the University of Manitoba in Canada, looked at 170,000 hospitalization events of all types in the U.S. and 1,300 in Manitoba, Canada.
Over the course of approximately a decade of data, the study found some dramatic differences in the experiences of young people with diabetes as they move through the system.
Losing access to healthcare endangers young diabetics
For teenagers, the diabetic ketoacidosis-related hospitalization rates of the two groups were nearly identical, with just a slightly higher rate of hospitalizations in the U.S among those aged 15 to17.
The dramatic shift occurs, however, when teenagers become young adults, the research demonstrated. For people with diabetes aged 19 to 21, the rate of DKA hospitalization surged to 9.2 per 10,000 population in the US, a 90% increase from the younger cohort.
Meanwhile, in Manitoba the rate increased only marginally, up 23% to 4.5 cases per 10,000 population.
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“Despite Obamacare, millions of Americans are uninsured, and the uninsurance rate is highest among young adults,” stated Dr. Andrea Christopher, one of the study’s lead authors and a primary care doctor at the University of Washington School of Medicine, in the study’s release. “Even with insurance, drug copayments are often so high that young people with diabetes can’t afford the insulin they need to survive.”
Without health insurance, insulin and other costly supplies such as test strips can become prohibitively expensive, leading people with type 1 diabetes to ration in dangerous ways as they attempt to stretch out limited resources.
Aging out of healthcare coverage
For many teens with type 1 diabetes in the United States, access to insulin is predicated on their parents’ jobs and benefits, because the majority – 55.7% of all Americans – receive employer-based health insurance.
“In American, 29 million are uninsured, while far more face unaffordable deductibles or sky-high
drug costs–including for insulin. The consequences can be deadly,” said Dr. Adam Gaffney, another of the study’s lead authors, who works as an instructor at Harvard Medical School and as a pulmonary and critical care physician at Cambridge Health Alliance.
The Affordable Care Act did expand access for many young people by allowing them to remain on their parents’ health insurance plans until the age of 26. However, the impact of this legislative change had not yet come into full effect by 2014, the last year in which data was examined by the researchers.
Even with expanded access to health insurance, however, young adults with type 1 diabetes face unique challenges in more ways than one. Over the course of the study, the list price of a vial of short-acting Humalog rose 585%, according to a statement from The Endocrine Society.
Combined with the prevalence of high-deductible plans, rising co-pays, and restrictive plans, access to insulin has created serious problems for both the insured and uninsured in the U.S.
DKA is one of the most dangerous health conditions that can strike people with diabetes, and the sharp spike in hospitalization rates points to the urgent need for reforms that make insulin more affordable and improve the health care system.