A Supplement to CareManagement CE FOR CCM & CDMS APPROVED FOR 1 HOUR OF CCM, CDMS, AND NURSING EDUCATION CREDIT
Addressing the Issues of Health Equity and Disability in Diabetes Care By Monica F. Nogueira Cordeiro, MD, and Alyson K. Myers, MD
INTRODUCTION Almost 12% of the US population, or around 38.4 million people, have diabetes, with higher rates among those with lower socioeco1 nomic status or lower levels of education. The financial burden of diabetes in 2022 was $412.9 billion dollars, 74% of which was due to direct medical costs. Approximately 1 in 4 health care dollars is spent on diabetes alone.2 Medications for comorbid conditions and inpatient admissions due to diabetes are the largest drivers of direct 2 medical costs. Use of inpatient diabetes teams has been associated with a decreased rate of 30-day hospital readmission and length of hospital stay, and lower hospital costs,3,4 but such teams are not readily available at all inpatient facilities. Access to such services is only one example of health inequity in diabetes care. There are numerous other disparities in diabetes care including prescribing differences, access to care inequities, health insurance variations (eg, Medicaid vs commercial insurance), and myriad 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 can “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 Box 1. Equity for people with diabetes is created and maintained by clinicians, health systems, and community, and fractures in such systems lead to inequity.5 The root cause of this fractured system is the social determinants of health (SDOH) that disallow patients to be on the same playing field.6 In addition, clinicians need cultural competence to address these SDOH6 because diabetes affects Black, Hispanic, and Indigenous patients at higher rates than White patients.1
HEALTH BARRIERS
SDOH have proven to be more important than medical treatment in determining longer life expectancy.7 Some of the SDOH that need to be assessed in diabetes management include, but are not
BOX 1
RIGHTS OF PEOPLE WITH DIABETES
• 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
limited to, health illiteracy and innumeracy, lack of transportation, food and housing insecurity, lack of access to technology, cultural beliefs and practices, and medication costs. Additional obstacles such as language and vision/hearing loss affect diabetes care, and clinician/staff bias should also be considered.
Health Illiteracy and Innumeracy Health illiteracy is often a major hindrance to achieving optimal health care, and there is a strong relationship between health illiteracy and health care outcomes.7 Health literacy lies on a spectrum. Monica F. Nogueira Cordeiro, MD, is a Postdoctoral Fellow in Endocrinology, Diabetes and Metabolism at the Albert Einstein College of Medicine, the Bronx, 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. She is also 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 | March 2024
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