A new study finds that people with diabetes may have poorer control of their condition if they experience difficulty paying for food and medication.
The researchers, including Dr. Seth A. Berkowitz of Massachusetts General Hospital, publish their findings in the journal JAMA Internal Medicine.
The Patient Protection and Affordable Care Act, also called Obamacare, was signed into law in the US in 2010. Its aim is to increase access to health insurance among individuals with low income.
However, the researchers say past studies have suggested that many low-income diabetes patients experience “material need insecurities” – such as problems paying for housing, household utilities, food and medications – that are “outside the scope of standard medical interventions,” and that these may affect their ability to manage the disease.
In their study, Dr. Berkowitz and colleagues set out to assess the impact of economic insecurity on diabetes control among 411 patients with the condition. Data from the patients were collected from two community health centers, a specialist diabetes treatment center and a primary care clinic in Massachusetts between June 2012 and October 2013.
Of the 411 patients, 19.1% reported difficulty paying for food, 27.6% reported underuse of medication due to cost, 10.7% reported housing instability and 14.1% reported difficulty paying for utilities. At least one material need insecurity was reported among 39.1% of patients.
From assessing patients’ hemoglobin A1c levels, low-density lipoprotein cholesterol levels or blood pressure, the team identified poor diabetes control among 46% of patients.
The researchers found that patients who reported difficulty paying for food and cost-related medication underuse were more likely to have poor diabetes control than those who did not have such insecurities.
Underuse of medication due to cost was also linked to increased emergency department visits, while housing instability and difficulty paying for utilities were linked to increased outpatient visits.
Furthermore, the team found that the more economic insecurities a patient had, the higher their likelihood of having poor diabetes control and using health care resources.
Commenting on their findings, the researchers say:
“Health care systems are increasingly accountable for health outcomes that have roots outside of clinical care.
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.”
The team admits their findings are subject to several limitations. They note, for example, that the results may be open to reverse causation; it is possible that food insecurity and medication underuse can worsen diabetes and increase the use of health care resources.
In addition, the researchers point out that their data did not capture all types of housing instability, and some that were missed – such as living in a single-room occupancy hotel and paying more than 50% of income in rent – may be clinically relevant.
“Thus,” the researchers add, “our data likely underestimate the true prevalence of housing instability. Furthermore, whether the addition of these other forms of housing instability would change the associations we observed remains unknown.”
Medical News Today recently reported on a study suggesting the risk of type 2 diabetes may be influenced by blood type.