Poor diabetes control linked to economic insecurity

Tue, 06 Jan 2015
People with diabetes who struggle to pay for food and medication in the US tend to have poorer control of their condition, according to a new study.

The study, published in the journal JAMA Internal Medicine, is focused on the US, and takes into account the difficulty of paying for medication. In the UK, the NHS makes this less of a problem, but the study nonetheless identifies the significant issue of diabetes control and economic security.

Researchers explained that past studies have indicated that low-income diabetes patients often experience "material need insecurities", which include problems paying for housing, household utilities, and food, costs that can affect one's ability to manage diabetes.

The study was conducted by collecting data from patients of two community health centres in Massachusetts - 411 patients in total, of which 19.1 per cent reported difficulty paying for food, 10.7 reported housing instability, and 14.1 per cent reported difficulty paying for utilities. 39.1 per cent had experienced at least one material insecurity.

46 per cent of the patients were classified as having "poor diabetes control", an assessment that involved examining HbA1c levels and low-density lipoprotein cholesterol levels or blood pressure.

Those patients who had experienced difficulty paying for food were significantly more likely to have poor diabetes control, the researchers discovered.

While the NHS provides medication for free, economic insecurity still poses a number of problems for people with diabetes in the UK. Test strips are not often provided for people with type 2 diabetes, making regular blood testing difficult, which in turn makes good blood glucose control more difficult to maintain.

In addition, food costs can force low-income families to select less healthy items in order to save money: purchasing white bread because of its low cost, for example, despite its lack of nutritional benefits. Not only does this impair diabetes control, but also increases the risk of non-diabetic people developing type 2 diabetes.

Dr. Joel Zonszein, director of the Clinical Diabetes Centre at Montefiore Medical Centre is New York City, said, "As can be expected, the more '[material] insecurities', the worse the outcomes.

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