“Checking the pulse” on diabetes disparities

Public health researchers take another look at how Americans living with diabetes seek care and are affected by health inequities
July 22, 2020

An alarming 10 percent of the United States population has diabetes, a potentially fatal, long-lasting health condition that affects how your body turns food into energy. Although many people are able to manage their symptoms and avoid hospital care, certain individual and place-based factors can affect diabetes management, which may lead to costly emergency department visits and hospitalizations.

“In an ideal health care system, people should be able to readily access outpatient care to get their illness under control earlier, as opposed to seeking care at an emergency department,” said Alva O. Ferdinand, DrPH, JD, assistant professor at the Texas A&M University School of Public Health and director of the Southwest Rural Health Research Center. “Generally, when we have adequate access to outpatient care, we should be able to avoid truly emergent health situations and potentially stay out of the hospital.”

Seeking emergency care and being hospitalized for a diabetes-related issue is undesirable for multiple reasons: it is costly for patients and their families, and it makes effectively allocating health care resources and improving health outcomes more difficult. Overall, poor diabetes management contributes to the growing cost of health care in the United States.

The extent to which emergency departments and hospitals across the nation are used for diabetes-related treatment is not fully known. Further, it is unclear whether certain regions of the United States are faring better than others in limiting emergency department-initiated hospitalizations for diabetes-related care. Thus, Ferdinand and colleagues recently investigated which individual and place-based factors most significantly affect the likelihood of seeking emergency care and subsequently being hospitalized for a diabetes-related issue.

The results of the study, published in the Journal of Diabetes, suggest that rural residents, racial and ethnic minorities, those who are uninsured, and residents of the South and Midwest census regions of the United States are more likely to seek emergency care and be hospitalized for treatment of a diabetes-related issue. These identified populations may be more vulnerable to challenges in managing their diabetes, such as provider shortages, distance between place of residence and place of care, inadequate transportation, food insecurity, financial insecurity and lack of knowledge about self-management.

Ferdinand hopes the study’s findings will be of interest to policy makers at the federal, state and local levels, as well as hospital administrators, faith-based organizations and other stakeholders interested in improving systems through which diabetes can be managed. For instance, new policies that can help rural residents access diabetes education and support could include expanding insurance coverage of diabetes self-management education, and providing diabetes self-management education in non-traditional venues (online or telehealth formats). Other initiatives may include better targeting diabetes management and education programs to minority populations through culture-centered approaches that take language, closely-held beliefs about nutrition and care seeking, and lifestyle into account.

“Stakeholders can help inform strategies that will make it so that the number of people being treated in the emergency department and subsequently in the hospital for diabetes is reduced, which will put less of a strain on our health care system,” Ferdinand said.

The researchers were not surprised by the findings in the study, as they reflect much of what similar studies have found using older data. However, Ferdinand said it’s important to “check the pulse” on what’s happening inside hospitals to stay up to date on where public health improvement is needed. The biggest take away from the study was that, “health disparities are real and they are persisting,” Ferdinand said. “We have a lot more work to do.”

– by Callie Rainosek

— Rae Lynn Mitchell

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