Diabetes mellitus type 2 control generally involves modifying the patient’s diet to include more healthy food choices, but a recently published report in the Journal of the American Medical Association (JAMA) suggests a possible link between poverty and mastering the art of controlling diabetic blood sugar levels. Doctors and nutritionists routinely dispense recommendations for healthier eating habits, to which few would disagree in principle. However, following through with the healthy diet plan appears to be more than just a matter of personal discipline, as the study found that patients with limited economic resources had a harder time accessing the fresh foods and medications needed for the most effective treatment of the chronic condition. As a result, they often find it more difficult to control the symptoms and progressive complications of their disease.
Massachusetts General Hospital’s Dr. Seth Berkowitz and his team conducted the study to discover any link between insecurities regarding material needs patients’ access to, and actual use of, recommended health resources and the outcomes in terms of how well controlled their diabetes mellitus type 2 was. Their sample population consisted of 411 patients from a diabetic treatment center, a primary care clinic and two community health centers followed from June 2012 to October 2013. Upon analyzing the data, they found about 19 percent of the diabetic patients reported anxiety over obtaining food. Over 27 percent shared an inability to obtain proper medication due to associated costs. Nearly 11 percent experienced instability in their living situation and about 14 percent found it difficult to cover their utility costs. Overall, approximately 39 percent communicated insecurity in covering the costs of one or more material needs. The correlation began to emerge when they found that 46 percent of the patients in the study showed signs of poor disease control such as high A1C, LDL cholesterol and blood pressure levels.
One implication of the link shown in these findings is that the Affordable Care Act is not the panacea for the diabetic ills of low-income patients. Access to medical care is all well and good, but without the resources to carry out the treatment for diabetes mellitus type 2 and provide the necessary foods and medicines, the patient’s health will still suffer. People who struggle to pay for basic needs such as housing and utilities carry a level of stress that is not conducive to allowing them to make the healthiest choices for control of their disease, as they are limited in what they can afford to provide for themselves. Thrift trumps personal preference, even in critical matters of health when budgets are stretched to the breaking point, as they are with individuals and families living below the poverty line.
The researchers concede that their results are not conclusive as the cause and effect relationship between food and medication shortages may flow in reverse. In other words, the increased use of healthcare systems may be due to the lack of proper nutrition and medical treatment aggravating the progress of the disease making it all the more difficult to control. Furthermore, they did not control for all types of housing instability, which may be a clinically significant factor. More research into the link between poverty and control of diabetes mellitus type 2 would clarify and substantiate the relationship.
Nonetheless, struggles with covering food and medication costs both carried a link to poor control of diabetes mellitus type 2 but not necessarily increased instances of seeking medical care. Different types of economic struggles seemed to parallel an inverse relationship between office and inpatient or emergency room visits. Food shortages appeared to cause a spike in office visits while medication shortages corresponded to a surge in emergency room visits and hospital stays. Researchers found no clear link between housing and utilities instabilities and diabetic control, although these factors did seem to contribute to a rising frequency of office visits. The more poverty-driven economic vulnerabilities a patient’s life circumstances present, the stronger the connection with inadequate control of the diabetes mellitus type 2 and the upsurge in using available resources in the healthcare system.
Although the root factors of controlling diabetes mellitus type 2 that the study identified fall outside the scope of medical practice or clinical influence, the results do point out a need to link access to quality healthcare with resources that can better address the social and economic needs of poverty. Such circumstances affect a patient’s overall health and disease management. Therefore, developing a holistic strategy that treats all aspects of the problem is a more promising approach to providing a practical blueprint for helping patients learn to manage their diabetes mellitus type 2 regardless of their economic standing.
by Tamara Christine Van Hooser
Image courtesy of Stephen Ausmus – Flickr License