Journal of general internal medicine · 2026
Impact of Health Insurance Coverage on Diabetes Care Quality: A Systematic Review and Meta-analysis of Racial, Ethnic, and Gender Disparities in U.S. Adults with Type 2 Diabetes.
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Gao Pengfei
Аннотация
BACKGROUND: Disparities in diabetes care persist in the United States (U.S.), a health concern. Health insurance influences access, yet its impact on outcomes populations remains uncertain. This systematic review and meta-analysis assesses insurance status affects care quality and evaluates racial, ethnic, and gender inequities among adults with type 2 diabetes.
METHODS: Following PRISMA 2020 guidelines, a systematic review and meta-analysis were conducted on 12 studies published between 2000 and 2025. Studies included adults with type 2 diabetes in the U.S. and reported outcomes by insurance type (private, Medicare, Medicaid, uninsured). Key diabetes care indicators assessed included HbA1c testing, blood pressure control, eye examinations, and LDL cholesterol testing. Random-effects models were used to pool effect sizes; heterogeneity and publication bias were evaluated using standard metrics.
RESULTS: Insurance coverage was significantly associated with increased likelihood of HbA1c testing (β = 0.2683, 95% CI [0.0531, 0.4835], p = 0.0145). The included studies were generally of moderate quality, with a moderate risk of bias according to the Newcastle-Ottawa Scale. Associations with blood pressure control, eye examinations, and LDL cholesterol control were not statistically significant and showed high heterogeneity. Racial and ethnic disparities in glycemic control persisted among insured individuals, with Hispanic/Latino and African American populations exhibiting poorer outcomes, and gender disparities were also observed, particularly in lipid control.
DISCUSSION: While insurance improves access to certain aspects of diabetes care, it does not eliminate racial, ethnic, or gender disparities. Addressing these inequities requires multifaceted policy approaches beyond insurance expansion, including attention to socio-economic and systemic barriers.
METHODS: Following PRISMA 2020 guidelines, a systematic review and meta-analysis were conducted on 12 studies published between 2000 and 2025. Studies included adults with type 2 diabetes in the U.S. and reported outcomes by insurance type (private, Medicare, Medicaid, uninsured). Key diabetes care indicators assessed included HbA1c testing, blood pressure control, eye examinations, and LDL cholesterol testing. Random-effects models were used to pool effect sizes; heterogeneity and publication bias were evaluated using standard metrics.
RESULTS: Insurance coverage was significantly associated with increased likelihood of HbA1c testing (β = 0.2683, 95% CI [0.0531, 0.4835], p = 0.0145). The included studies were generally of moderate quality, with a moderate risk of bias according to the Newcastle-Ottawa Scale. Associations with blood pressure control, eye examinations, and LDL cholesterol control were not statistically significant and showed high heterogeneity. Racial and ethnic disparities in glycemic control persisted among insured individuals, with Hispanic/Latino and African American populations exhibiting poorer outcomes, and gender disparities were also observed, particularly in lipid control.
DISCUSSION: While insurance improves access to certain aspects of diabetes care, it does not eliminate racial, ethnic, or gender disparities. Addressing these inequities requires multifaceted policy approaches beyond insurance expansion, including attention to socio-economic and systemic barriers.