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Table 1

Adjusted monthly diabetes-related OOPE rates for the associations with demographic and treatment variables among participants with type 1 diabetes, using interval-censored regression models

Variable (%)Model 1Model 2Model 3
Monthly OOPE rate (95% CI)PMonthly OOPE rate (95% CI)PMonthly OOPE rate (95% CI)P
Age (in years) 0.99 (0.97, 1.01) 0.50 1.0 (0.98, 1.03) 0.93 1.00 (0.75, 1.33) 0.79 
Diabetes duration (in years) 1.00 (0.96, 1.05) 0.99 1.0 (0.95, 1.05) 0.93 1.01 (0.99, 1.01) 0.51 
Race/ethnicity       
 Non-Hispanic black (11) 0.66 (0.51, 0.85) 0.006 0.76 (0.57, 1) 0.12 1.00 (0.75, 1.33) 0.60 
 Hispanic (12) 0.77 (0.6, 0.99)  0.79 (0.6, 1.04)  0.85 (0.65, 1.11)  
 Other (2.5) 0.82 (0.51, 1.33)  1.07 (0.63, 1.84)  0.82 (0.48, 1.4)  
 Non-Hispanic white (74.5) Reference  Reference  Reference  
Sex       
 Female (50.1) 0.92 (0.78, 1.07) 0.28 0.88 (0.75, 1.04) 0.14 0.88 (0.75, 1.04) 0.14 
 Male (49.9) Reference  Reference  Reference  
Level of parental education       
 Bachelor’s degree or more (51.6) 1.45 (1.1, 1.91) 0.0001 1.3 (0.97, 1.74) 0.002 1.05 (0.82, 1.33) 0.01 
 Some college (33.3) 1.11 (0.85, 1.46)  1.06 (0.8, 1.41)  0.9(0.68, 1.19)  
 Less than high school (3.8) 0.59 (0.37, 0.93)  0.53 (0.33, 0.87)  0.53 (0.33, 0.85)  
 High school graduate (11.25) Reference  Reference  Reference  
Median household income       
 $75,000+ (38) 1.27 (1.01, 1.61) <0.0001 1.22(0.96, 1.56) <0.0001 1.04(0.82, 1.32) 0.004 
 $50,000–74,000 (16.1) Reference  Reference  Reference  
 $25,000–49,000 (16.9) 0.71 (0.54, 0.93)  0.73 (0.55, 0.97)  0.82 (0.62, 1.08)  
 <$25,000 (16) 0.37 (0.28, 0.49)  0.39 (0.29, 0.52)  0.61 (0.45, 0.82)  
 Did not know/refused (13.1) 0.89 (0.66, 1.2)  0.88 (0.64, 1.2)  0.89 (0.65, 1.21)  
Type of diabetes provider       
 Adult endocrinologist (16.9) 1.51 (1.17, 1.94) 0.03 1.62 (1.24, 2.12) 0.005 1.44 (1.11, 1.87) 0.003 
 Family practice doctor (3.7) 1.32 (0.85, 2.05)  1.72 (1.07, 2.77)  1.98 (1.21, 3.22)  
 None/no source of medical care (1.2) 1.01 (0.49, 2.08)  1.08 (0.48, 2.41)  0.59 (0.24, 1.49)  
 Other (19.3) 1.10 (0.89, 1.35)  1.12 (0.9, 1.4)  1.05 (0.85, 1.31)  
 Pediatric endocrinologist (58.9) Reference  Reference  Reference  
HbA1c, age-specific       
 Intermediate (40.7)   1.05 (0.8, 1.38) 0.72 0.96 (0.73, 1.27) 0.54 
 Poor (47.1)   1.11 (0.84, 1.46)  1.07 (0.8, 1.42)  
 Good (12.3)   Reference  Reference  
BMI       
 <85th percentile (66.6)   Reference 0.26 Reference 0.32 
 85th–95th percentile (20.8)   0.93 (0.76, 1.13)  0.95 (0.78, 1.16)  
 >95th percentile (12.6)   0.82 (0.64, 1.05)  0.85 (0.66, 1.08)  
Insulin regimen       
 Insulin injections including long acting (35.6)   0.84 (0.7, 1.01) 0.01 0.78 (0.65, 0.94) 0.004 
 Insulin injections excluding long acting (8.3)   0.63 (0.45, 0.87)  0.63 (0.45, 0.86)  
 Pump therapy (56.1)   Reference  Reference  
Frequency of SMBG       
 Did not use a glucometer (2.2)   1.06 (0.59, 1.89) 0.37 1.06 (0.59, 1.89) 0.45 
 Less than once a day, only when sick (12.6)   1.09 (0.84, 1.42)  1.09 (0.84, 1.42)  
 1–2 times a day (10.4)   0.99 (0.75, 1.32)  0.99 (0.75, 1.32)  
 3 times a day (13.6)   1.13 (0.87, 1.45)  1.13 (0.87, 1.45)  
 4–6 times a day (50.4)   Reference  Reference  
 ≥7 times a day (10.8)   1.38 (1.03, 1.85)  1.26 (0.94, 1.69)  
CGM use       
 Yes (17.4)   1.29 (1.03, 1.62) 0.03 1.35 (1.08, 1.68) 0.01 
 No (78.3)   Reference  Reference  
Health insurance       
 None (3.3)     0.83 (0.5, 1.38) <0.0001 
 Other/Medicaid/Medicare (25.7)§     0.22 (0.18, 0.27)  
 Private (71)     Reference  
Variable (%)Model 1Model 2Model 3
Monthly OOPE rate (95% CI)PMonthly OOPE rate (95% CI)PMonthly OOPE rate (95% CI)P
Age (in years) 0.99 (0.97, 1.01) 0.50 1.0 (0.98, 1.03) 0.93 1.00 (0.75, 1.33) 0.79 
Diabetes duration (in years) 1.00 (0.96, 1.05) 0.99 1.0 (0.95, 1.05) 0.93 1.01 (0.99, 1.01) 0.51 
Race/ethnicity       
 Non-Hispanic black (11) 0.66 (0.51, 0.85) 0.006 0.76 (0.57, 1) 0.12 1.00 (0.75, 1.33) 0.60 
 Hispanic (12) 0.77 (0.6, 0.99)  0.79 (0.6, 1.04)  0.85 (0.65, 1.11)  
 Other (2.5) 0.82 (0.51, 1.33)  1.07 (0.63, 1.84)  0.82 (0.48, 1.4)  
 Non-Hispanic white (74.5) Reference  Reference  Reference  
Sex       
 Female (50.1) 0.92 (0.78, 1.07) 0.28 0.88 (0.75, 1.04) 0.14 0.88 (0.75, 1.04) 0.14 
 Male (49.9) Reference  Reference  Reference  
Level of parental education       
 Bachelor’s degree or more (51.6) 1.45 (1.1, 1.91) 0.0001 1.3 (0.97, 1.74) 0.002 1.05 (0.82, 1.33) 0.01 
 Some college (33.3) 1.11 (0.85, 1.46)  1.06 (0.8, 1.41)  0.9(0.68, 1.19)  
 Less than high school (3.8) 0.59 (0.37, 0.93)  0.53 (0.33, 0.87)  0.53 (0.33, 0.85)  
 High school graduate (11.25) Reference  Reference  Reference  
Median household income       
 $75,000+ (38) 1.27 (1.01, 1.61) <0.0001 1.22(0.96, 1.56) <0.0001 1.04(0.82, 1.32) 0.004 
 $50,000–74,000 (16.1) Reference  Reference  Reference  
 $25,000–49,000 (16.9) 0.71 (0.54, 0.93)  0.73 (0.55, 0.97)  0.82 (0.62, 1.08)  
 <$25,000 (16) 0.37 (0.28, 0.49)  0.39 (0.29, 0.52)  0.61 (0.45, 0.82)  
 Did not know/refused (13.1) 0.89 (0.66, 1.2)  0.88 (0.64, 1.2)  0.89 (0.65, 1.21)  
Type of diabetes provider       
 Adult endocrinologist (16.9) 1.51 (1.17, 1.94) 0.03 1.62 (1.24, 2.12) 0.005 1.44 (1.11, 1.87) 0.003 
 Family practice doctor (3.7) 1.32 (0.85, 2.05)  1.72 (1.07, 2.77)  1.98 (1.21, 3.22)  
 None/no source of medical care (1.2) 1.01 (0.49, 2.08)  1.08 (0.48, 2.41)  0.59 (0.24, 1.49)  
 Other (19.3) 1.10 (0.89, 1.35)  1.12 (0.9, 1.4)  1.05 (0.85, 1.31)  
 Pediatric endocrinologist (58.9) Reference  Reference  Reference  
HbA1c, age-specific       
 Intermediate (40.7)   1.05 (0.8, 1.38) 0.72 0.96 (0.73, 1.27) 0.54 
 Poor (47.1)   1.11 (0.84, 1.46)  1.07 (0.8, 1.42)  
 Good (12.3)   Reference  Reference  
BMI       
 <85th percentile (66.6)   Reference 0.26 Reference 0.32 
 85th–95th percentile (20.8)   0.93 (0.76, 1.13)  0.95 (0.78, 1.16)  
 >95th percentile (12.6)   0.82 (0.64, 1.05)  0.85 (0.66, 1.08)  
Insulin regimen       
 Insulin injections including long acting (35.6)   0.84 (0.7, 1.01) 0.01 0.78 (0.65, 0.94) 0.004 
 Insulin injections excluding long acting (8.3)   0.63 (0.45, 0.87)  0.63 (0.45, 0.86)  
 Pump therapy (56.1)   Reference  Reference  
Frequency of SMBG       
 Did not use a glucometer (2.2)   1.06 (0.59, 1.89) 0.37 1.06 (0.59, 1.89) 0.45 
 Less than once a day, only when sick (12.6)   1.09 (0.84, 1.42)  1.09 (0.84, 1.42)  
 1–2 times a day (10.4)   0.99 (0.75, 1.32)  0.99 (0.75, 1.32)  
 3 times a day (13.6)   1.13 (0.87, 1.45)  1.13 (0.87, 1.45)  
 4–6 times a day (50.4)   Reference  Reference  
 ≥7 times a day (10.8)   1.38 (1.03, 1.85)  1.26 (0.94, 1.69)  
CGM use       
 Yes (17.4)   1.29 (1.03, 1.62) 0.03 1.35 (1.08, 1.68) 0.01 
 No (78.3)   Reference  Reference  
Health insurance       
 None (3.3)     0.83 (0.5, 1.38) <0.0001 
 Other/Medicaid/Medicare (25.7)§     0.22 (0.18, 0.27)  
 Private (71)     Reference  

Model 1 examines OOPE with adjustment for nonmodifiable characteristics including age, diabetes duration, race/ethnicity, sex, highest level of parental education, household income, type of diabetes provider, and SEARCH site. Model 2 builds on model 1 with addition of modifiable clinical variables including HbA1c, BMI, insulin regimen, and frequency of SMBG and CGM use. Model 3 builds upon model 2, controlling for health insurance.

SMBG, self-monitoring of blood glucose.

We defined glycemic control based on the following HbA1c level cutoffs. For participants <18 years old, glycemic control is good with HbA1c <7.5%, intermediate with HbA1c 7.5% to <9%, and poor with HbA1c >9.0%. For participants ≥18 years old, glycemic control is good with HbA1c <7%, intermediate with HbA1c 7% to <9%, and poor with HbA1c >9.0%.

§

Other insurance categories include school-based insurance and Tribe/Indian Health Service.

P value of the omnibus test for comparing the different subgroups with the reference.

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