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Economic Insecurities Linked to Poor Diabetes Control

Seth A. Berkowitz, MD, MPH, of the division of general internal medicine at Massachusetts General Hospital in Boston stated that, “Material need insecurities are common and addressing them is complicated.” “In my opinion, this is a problem that needs to be tackled at the level of the health system, rather than the level of an individual clinician, by thinking carefully about the problems of the community served by the health care systems, and thinking about addressing the problems in two ways — helping patients get linked to existing social services and expanding the scope of services offered by the health care system.”

Berkowitz and colleagues evaluated 411 adults aged at least 21 years with diabetes to determine the association between food insecurity, cost-related medication underuse, housing instability and energy insecurity with control of diabetes as well as the use of health care resources.

At least one material need insecurity was reported by 39.1% of participants. The most common was cost-related medication underuse (27.6%) followed by food insecurity (19.1%), energy insecurity (14.1%) and housing instability (10.7%).

Poor diabetes control was more common among participants with food insecurity (64.1%) vs. 41.6% of food-secure participants (P=.001). In unadjusted analyses, increased outpatient visits were associated with all four material need insecurities whereas increased ED/inpatient visits were associated only with cost-related medical underuse.

In adjusted analyses, an association was found between food insecurity and poor diabetes control as well as increased outpatient visits, but not increased ED/inpatient visits.

Similarly, an association was found between cost-related medication underuse and poor diabetes control as well as increased ED/inpatient visits, but not increased outpatient visits.
Each increasing number of material need insecurity was linked to increased odds of poor diabetes control. Poor glycemic control and poor control of LDL-cholesterol levels were associated with food insecurity; however, poor blood pressure control was not associated with it. Increased odds of poor glycemic control, poor control of LDL-cholesterol levels and poor blood pressure control were all associated with cost-related medication underuse.

“Health care systems are increasingly accountable for health outcomes that have roots outside of critical care,” the researchers wrote. “Because of this development, strategies that increase access to health care resources might reasonably be coupled with those that address social determinants of health, including material need insecurities. In particular, food insecurity and cost-related medication underuse may be promising targets for real-world management of diabetes mellitus.”

Practice Pearls:

  • Material need insecurities are common and addressing them is complicated.
  • The most common was cost-related medication underuse (27.6%) followed by food insecurity (19.1%), energy insecurity (14.1%) and housing instability (10.7%).
  • Poor glycemic control and poor control of LDL-cholesterol levels were associated with food insecurity.

Berkowitz SA. JAMA Intern Med. 2014;doi:10.1001/jamainternmed.2014.6888. January 2nd, 2015

July 7, 2016 Uncategorized
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