A Supplement to CareManagement CE FOR CCM & CDMS APPROVED FOR 1 HOUR OF CCM, CDMS, AND NURSING EDUCATION CREDIT
Health Equity and Disability Issues in Diabetes Care Trisha Menon, MD, and Alyson K. Myers, MD
INTRODUCTION Almost 11% of the United States population, or around 37.3 million people, have diabetes, with higher rates among those with lower socioeconomic status or lower levels of education.1 The financial burden of diabetes in 2017 was $327 billion dollars, 72% of which was due to direct medical costs.2 Approximately 1 in 4 health care dollars is spent on diabetes alone.3 Medications for comorbid conditions and inpatient admissions due to diabetes are the largest drivers of high direct medical costs.2 Use of inpatient diabetes teams have been associated with a decreased rate of 30-day hospital readmission, decreased length of hospital stay, and lower hospital costs4,5 but are not readily available at all inpatient facilities. Access to such services is only one example of health inequity in diabetes care. There are also numerous other disparities in diabetes care including prescribing differences, access to care, health insurance variations (eg, Medicaid vs. commercial insurance), and a myriad of other social determinants of health (eg, low health literacy) that can impact diabetes care. The goals of this paper are to define health equity, describe examples of health inequity, and describe solutions that case managers can use when caring for people with diabetes. HEALTH EQUITY According to the Centers for Disease Control and Prevention (CDC), health equity is achieved when every person has the opportunity to “attain his or her full health potential” and no one is “disadvantaged from achieving this potential because of social position or other socially determined circumstances.” The American Diabetes Association (ADA) Health Equity Now Bill outlines certain rights shown in Table 1. Equity for people with diabetes is created and maintained by providers, health systems, and community, and fractures in such systems lead to inequity.6 The root cause of this fractured system is the social determinants of health (SDOH) that disallow patients to be on the same playing field.7 In addition, providers need to be versed in how to address these SDOH as well as cultural competency7 because diabetes affects Blacks, Hispanics, and American Indians at higher rates than Whites.1 HEALTH BARRIERS SDOH have proven to be more important than medical treatment with regard to longer life expectancy.8 Some of the SDOH
TABLE 1
THE AMERICAN DIABETES ASSOCIATION HEALTH EQUITY BILL OF RIGHTS
• The right to access insulin and other drugs affordably. • The right to healthy food. • The right to health insurance that covers diabetes management and future cures. • The right not to face stigma or discrimination. • The right to avoid preventable amputations. • The right to participate in clinical trials without fear. • The right to stop prediabetes from becoming diabetes. • The right to build an environment that does not put you at greater risk for getting diabetes. • The right to the latest medical advances. The right to have your voice heard. that need to be assessed in diabetes management include but are not limited to health literacy, transportation, food and housing insecurity, lack of access to technology, culture, and medication costs. Additional disabilities such as language and visual/hearing barriers affect diabetes care, and provider/staff education is often a limitation as well.
Trisha Menon, MD, is a Fellow in Endocrinology, Diabetes and Metabolism at North Shore University Hospital, Manhasset, New York, and Long Island Jewish Medical Center, Queens, New York. Alyson K. Myers, MD is an attending endocrinologist, Associate Professor, and Associate Chair of Diversity, Equity, Inclusion, in the Department of Medicine, Montefiore Medical Center: Einstein Campus, the Bronx, New York, and an Adjunct Professor at the Zucker School of Medicine, Hofstra/Northwell, Uniondale, New York.
This publication was supported by an unrestricted grant from Abbott Diabetes Care | September 2022
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