Access to Care and Diabetes Management Among Older American Indians With Type 2 Diabetes

J Aging Health. 2017 Mar;29(2):206-221. doi: 10.1177/0898264316635562. Epub 2016 Jul 9.


Objective: To examine the relationship between health care access and diabetes management among a geographically diverse sample of American Indians (AIs) aged 50 and older with type 2 diabetes.

Method: We examined the relationship between access to care and diabetes management, as measured by HbA1c, using 1998-1999 data from the Strong Heart Family Study. A series of bivariate and multivariate linear models examined the relationships between nine access-related variables and HbA1c levels.

Results: In bivariate analyses, out-of-pocket costs were associated with higher HbA1c levels. No other access-related characteristics were significantly associated with diabetes management in bivariate or in multivariate models.

Discussion: Access-related barriers were not associated with worse diabetes management in multivariate analyses. The study concludes with implications for clinicians working with AI populations to enhance opportunities for diabetes management.

Keywords: American Indians; access to care; diabetes; health services; rural aging.

MeSH terms

  • Aged
  • Diabetes Mellitus, Type 2* / drug therapy
  • Diabetes Mellitus, Type 2* / therapy
  • Female
  • Health Services Accessibility* / economics
  • Health Services Accessibility* / statistics & numerical data
  • Humans
  • Indians, North American*
  • Male
  • Middle Aged
  • Rural Population
  • United States