Poverty Makes Diabetes Care Tougher, Study Reports

Too little money for food, housing and medicine affects disease management

Monday, December 29, 2014

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MONDAY, Dec. 29, 2014 (HealthDay News) -- People with diabetes who have difficulty paying for food, medicine and other basic needs also have trouble managing their diabetes, a new study finds.

Those who have trouble paying for food or medicine had the highest risk of poor diabetes control, according to the study. Poor control means higher blood sugar, cholesterol and blood pressure than normal, the researchers said.

"Despite insurance coverage, unmet basic needs were common, associated with worse diabetes control, and high use of expensive health services," said lead author Dr. Seth Berkowitz, a research fellow in medicine at Harvard Medical School.

"If we do not try to address these needs specifically, we may make little progress in improving health for vulnerable diabetes patients," he said.

Historically, patients come in for office visits or hospitalizations, but most of their time -- the time that determines their overall health -- is spent outside the health care system, Berkowitz noted.

Health care systems are being held accountable for health outcomes, but these outcomes may be determined by situations that most health care systems have limited experience dealing with, he said.

"This study suggests that simply increasing access to health care that does not address root causes of illness may be missing a big piece of what patients need to stay healthy and manage their illnesses," Berkowitz said.

However, Berkowitz thinks that the Affordable Care Act may help address these needs.

"Changes in health care financing could encourage health care delivery systems to think about population health management in a way that gives room to address issues not classically thought of as medical, like unmet basic needs," he said.

Medicaid is likely to be helpful, especially for prescription medication coverage, he said.

As for where people can turn for help, Berkowitz said that unfortunately, there isn't a single easy answer.

Social services -- both public and private -- in the United States are a "patchwork" so the answer will be different for each person, he said.

The report was published Dec. 29 online in JAMA Internal Medicine.

Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said, "As can be expected, the more 'insecurities,' the worse the outcomes."

"This study also proves that diabetes is a complex disease to treat and social variables play an important role that cannot be easily controlled by the government," he said.

For the study, Berkowitz's team collected data on more than 400 people with diabetes. They were seen at two community health centers in Massachusetts from June 2012 through October 2013.

The researchers found that 19 percent of the patients said they had trouble affording food; 28 percent said they had problems paying for medications; 11 percent had problems paying for a place to live, and 14 percent had difficulty paying utility bills. Nearly 40 percent of those surveyed had difficulty paying for one of these needs, the researchers found.

Almost half of the respondents -- 46 percent -- had trouble with diabetes management.

The researchers found that financial problems affected diabetes management in varying ways.

For example, having problems affording food significantly upped the odds of poor diabetes control and increased clinic visits, but did not affect visits to the emergency room or hospitalizations.

Trouble paying for medicine was also linked to poor diabetes control and more emergency room visits, but did not affect clinic visits, the researchers noted.

Problems paying for housing or utilities were associated with more clinic visits, but not with poor diabetes control or with emergency room visits, according to the study.

SOURCES: Seth Berkowitz, M.D., M.P.H., research fellow in medicine, Harvard Medical School, Boston; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, New York City; Dec. 29, 2014, JAMA Internal Medicine

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