Social determinants of health and recommended A1C monitoring among women with postpartum-onset diabetes: results from a retrospective cohort

Introduction Diabetes is increasingly prevalent in reproductive-aged women, but the association between social determinants of health (SDOH) and access to A1C monitoring after diagnosis are poorly understood. We explored SDOH and receipt of recommended follow-up A1C testing among postpartum women with diabetes.Research design and methods A retrospective, population-based cohort of 5,590 women who delivered in New York City between 2009–2016 and experienced postpartum-onset diabetes. We explored associations between SDOH (race-ethnicity, nativity, insurance, nutrition program enrollment, education, and parity) and time to first follow-up test/rate of A1C testing using Cox proportional hazards and Poisson regression, respectively. We constructed models that were unadjusted, mutually adjusted, and further adjusted for clinical characteristics (body mass index, gestational diabetes mellitus, and age).Results Few women received all biannual recommended follow-up tests over the study period (13.0%). Non-Hispanic Black women were more likely to receive their first follow-up test later (adjusted HR (aHR): 0.90, 95% CI 0.80 to 1.00) and had a lower rate of testing over 3 years (adjusted rate ratio (aRR): 0.92, 95% CI 0.84 to 0.99) compared with non-Hispanic White women. Women insured by Medicaid at delivery experienced a higher hazard of an earlier first follow-up A1C test (aHR: 1.14, 95% CI 1.06 to 1.22) and higher rates of testing (aRR: 1.09, 95% CI 1.03 to 1.15) than those with private or other insurance. Women with more children experienced lower rates of testing and a longer time to first A1C test compared with those with no prior children.Conclusions Few women with postpartum-onset diabetes met A1C monitoring guidelines, suggesting a need to improve routine diabetes monitoring, particularly among Black women. The finding of an advantage in testing among people insured by Medicaid is promising. Additional research should explore mechanisms through which Medicaid insurance and other structural interventions may improve access to and engagement in routine diabetes care.