Health Care Access and Glycemic Control Among U.S. Adults With Diabetes: Analysis of National Health and Nutrition Examination Survey, 2011–2018

Background Diabetes remains a major public health concern in the United States, with suboptimal glycemic control contributing to increased risk of complications. Access to health care is often considered important for diabetes management, yet its relationship with glycemic outcomes remains inconsistent. Objective This study examined the association between health care access and glycemic control among U.S. adults with diabetes using nationally representative data. Methods A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. The study included adults aged 18 years or older with diabetes. Poor glycemic control was defined as glycated haemoglobin (HbA1c) ≥ 7%. Health care access measures included insurance status, usual source of care, and health care visits. Survey-weighted logistic regression was used to estimate adjusted associations while accounting for the complex sampling design. Results Health care access variables were not significantly associated with poor glycemic control after adjustment. Male sex and Hispanic ethnicity were associated with higher odds of poor glycemic control. Other demographic and clinical variables showed no significant associations. Conclusion This study highlights that health care access alone may not explain differences in glycemic control. Broader factors related to patient characteristics and social conditions should be considered in efforts to improve diabetes outcomes.