Trends and Predictors of Glycemic Control Among Adults With Type 2 Diabetes Covered by Alabama Medicaid, 2011–2019

INTRODUCTION: Despite advances in diabetes management, only one-quarter of people with diabetes in the US achieve optimal targets for glycated hemoglobin A(1c) (HbA(1c)), blood pressure, and cholesterol. We sought to evaluate temporal trends and predictors of achieving glycemic control among adults with type 2 diabetes covered by Alabama Medicaid from 2011 through 2019. METHODS: We completed a retrospective analysis of Medicaid claims and laboratory data, using person-years as the unit of analysis. Inclusion criteria were being aged 19 to 64 years, having a diabetes diagnosis, being continuously enrolled in Medicaid for a calendar year and preceding 12 months, and having at least 1 HbA(1c) result during the study year. Primary outcomes were HbA(1c) thresholds of <7% and <8%. Primary exposure was study year. We conducted separate multivariable-adjusted logistic regressions to evaluate relationships between study year and HbA(1c) thresholds. RESULTS: We included 43,997 person-year observations. Mean (SD) age was 51.0 (9.9) years; 69.4% were women; 48.1% were Black, 42.9% White, and 0.4% Hispanic. Overall, 49.1% had an HbA(1c) level of <7% and 64.6% <8%. Later study years and poverty-based eligibility were associated with lower probability of reaching target HbA(1c) levels of <7% or <8%. Sex, race, ethnicity, and geography were not associated with likelihood of reaching HbA(1c) <7% or <8% in any model. CONCLUSION: Later study years were associated with lower likelihood of meeting target HbA(1c) levels compared with 2011, after adjusting for covariates. With approximately 35% not meeting an HbA(1c) target of <8%, more work is needed to improve outcomes of low-income adults with type 2 diabetes.