Seth A. Berkowitz|James B. Meigs|Darren A. DeWalt|Hilary K. Seligman|Lily S. Barnard|Oliver-John M. Bright|Marie Schow|Steven J. Atlas|Deborah J. Wexler
Material Need Insecurities, Control of Diabetes Mellitus, and Use of Health Care Resources
Massachusetts General Hospital|Harvard University|Massachusetts General Hospital|Harvard University|University of North Carolina at Chapel Hill|San Francisco General Hospital|University of California, San Francisco|Tufts University|Tufts University|Tufts University|Massachusetts General Hospital|Harvard University|Massachusetts General Hospital|Harvard University
increasing access care may insufficient improve health patients diabetes mellitus unmet basic needs hereinafter referred material need insecurities specific material need insecurities relate clinical outcomes use health care resources setting nearuniversal access health care unclearto determine association food insecurity costrelated medication underuse housing instability energy insecurity control diabetes mellitus use health care resourcescrosssectional data collected june 1 2012 october 31 2013 1 academic primary care clinic 2 community health centers 1 specialty center treatment diabetes mellitus massachusetts random sample 411 patients stratified clinic consisted adults aged 21 years diabetes mellitus response rate 623the prespecified primary outcome composite indicator poor diabetes control hemoglobin a1c level 90 lowdensity lipoprotein cholesterol level 100 mgdl blood pressure 14090 mm hg prespecified secondary outcomes included outpatient visits composite emergency department ed visits acute care hospitalizations edinpatient visitsoverall 191 respondents reported food insecurity 276 costrelated medication underuse 107 housing instability 141 energy insecurity 391 least 1 material need insecurity poor diabetes control observed 460 respondents multivariable models food insecurity associated greater odds poor diabetes control adjusted odds ratio 197 95 ci 158247 increased outpatient visits adjusted incident rate ratio irr 119 95 ci 105136 increased edinpatient visits irr 100 95 ci 051197 costrelated medication underuse associated poor diabetes control 191 95 ci 135270 increased edinpatient visits irr 168 95 ci 121234 outpatient visits irr 107 95 ci 095121 housing instability irr 131 95 ci 114151 energy insecurity irr 112 95 ci 100125 associated increased outpatient visits diabetes control 110 95 ci 060202 127 95 ci 096169 respectively edinpatient visits irr 149 95 ci 081273 irr 131 95 ci 080213 respectively increasing number insecurities associated poor diabetes control additional need 139 95 ci 118163 increased use health care resources irr outpatient visits 109 95 ci 103115 irr edinpatient visits 122 95 ci 099151material need insecurities common among patients diabetes mellitus varying generally adverse associations diabetes control use health care resources material need insecurities may important targets improving care diabetes mellitus