{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T03:30:36Z","timestamp":1791948636860,"version":"4.3.4"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Preventing diabetes complications requires monitoring and control of hyperglycemia and cardiovascular risk factors. Switching to high-deductible health plans (HDHPs) has been shown to hinder aspects of diabetes care; however, the association of HDHP enrollment with microvascular and macrovascular diabetes complications is unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the association between an employer-required switch to an HDHP and incident complications of diabetes.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study used deidentified administrative claims data for US adults with diabetes enrolled in employer-sponsored health plans between January 1, 2010, and December 31, 2019. Data analysis was performed from May 26, 2022, to January 2, 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Adults with a baseline year of non-HDHP enrollment who had to switch to an HDHP because their employer offered no non-HDHP alternative in that year were compared with adults who were continuously enrolled in a non-HDHP.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Mixed-effects logistic regression models examined the association between switching to an HDHP and, individually, the odds of myocardial infarction, stroke, hospitalization for heart failure, lower-extremity complication, end-stage kidney disease, proliferative retinopathy, treatment for retinopathy, and blindness. Models were adjusted for demographics, comorbidities, and medications, with inverse propensity score weighting used to account for potential selection bias.<\/jats:p><\/jats:sec>Results<\/jats:title>The study included 42\u202f326 adults who switched to an HDHP (mean [SD] age, 52 [10] years; 19\u202f752 [46.7%] female) and 202\u202f729 adults who did not switch (mean [SD] age, 53 [10] years; 89\u202f828 [44.3%] female). Those who switched to an HDHP had greater odds of experiencing all diabetes complications (odds ratio [OR], 1.11; 95% CI, 1.06-1.16 for myocardial infarction; OR, 1.15; 95% CI, 1.09-1.21 for stroke; OR, 1.35; 95% CI, 1.30-1.41 for hospitalization for heart failure; OR, 2.53; 95% CI, 2.38-2.70 for end-stage kidney disease; OR, 2.23; 95% CI, 2.17-2.29 for lower-extremity complication; OR, 1.17; 95% CI, 1.13-1.21 for proliferative retinopathy; OR, 2.35; 95% CI, 2.18-2.54 for blindness; and OR, 2.28; 95% CI, 2.15-2.41 for retinopathy treatment).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study found that an employer-driven switch to an HDHP was associated with increased odds of experiencing all diabetes complications. These findings reinforce the potential harm associated with HDHPs for people with diabetes and the importance of affordable and accessible chronic disease management, which is hindered by high out-of-pocket costs incurred by HDHPs.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.3394","type":"journal-article","created":{"date-parts":[[2024,3,22]],"date-time":"2024-03-22T15:32:25Z","timestamp":1711121545000},"page":"e243394","source":"Crossref","is-referenced-by-count":10,"title":["Enrollment in High-Deductible Health Plans and Incident Diabetes Complications"],"prefix":"10.1001","volume":"7","author":[{"given":"Rozalina G.","family":"McCoy","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore"},{"name":"University of Maryland Institute for Health Computing, Bethesda"},{"name":"Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore"},{"name":"Department of Health Policy and Management, University of Maryland School of Public Health, College Park"},{"name":"OptumLabs, Eden Prairie, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavya S.","family":"Swarna","sequence":"additional","affiliation":[{"name":"OptumLabs, Eden Prairie, Minnesota"},{"name":"Robert D. and Patricia E. 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