Association between insurance status and access to health care with diabetes management and control in Switzerland

Aim : We assessed whether diabetes treatment and control are associated with access to health care and with health insurance status. Methods : Two cross-sectional surveys (S1: 2014-2017 and S2: 2018-2021) of an ongoing prospective study conducted in Lausanne, Switzerland. Participants with diabetes were queried regarding their access to health care and health insurance. Results : We selected 232 (67.5±9.1 years, 31.0% women, 75.8% on antidiabetic drug treatment) and 245 (68.1±9.0 years, 38.0% women, 75.5% on antidiabetic drug treatment) participants in S1 and S2, respectively. Treated participants chose more frequently an ordinary insurance with a lower franchise than untreated (81.6% vs. 65.0%, p=0.024). Most treated participants had consulted a doctor in the previous 12 months (94.9% in S1 and 80.0% in S2) while a minority consulted a diabetologist (24.3%) or an ophthalmologist (34.6%). Among treated participants, diabetic control remained suboptimal (40.9% in S1 and 38.9% in S2 for HbA 1 c<48 mmol/mol, the corresponding values being 67.0% and 63.2% for HbA 1 c<53 mmol/mol). Controlled (HbA 1 c<48 mmol/mol) diabetes tended to be associated with a lower frequency of hospitalizations: odds ratio and (95% CI) 0.54 (0.24-1.24), p=0.148, and this association became significant after inverse probability weighting, 0.29 (0.10-0.81). Conversely, no association was found for less stringent diabetes control levels (HbA 1 c<53 or 64 mmol/mol). Similar findings were obtained for consulting a diabetologist. Conclusion : Diabetes control and consultation of a diabetologist or an ophthalmologist by participants with diabetes are still suboptimal in Lausanne. More stringent diabetes control is associated with lower hospitalization rates.