Life with Diabetes: Reducing Barriers to Care
Over 36 million people in the United States have type 2 diabetes, according to the American Diabetes Association (ADA), whose mission is to prevent and cure diabetes and to improve the lives of all people affected by the disease. No matter where people are in their health journey, the ADA has the resources and tools needed to live and thrive with diabetes.
Real World Health Care recently interviewed several leaders of the ADA about the obstacles faced by people living with diabetes and how the ADA is helping to address those obstacles. Read on for insights from the ADA’s:
- Rene Gonzalez, Director, Health Equity and Community Impact
- Robert Gabbay, MD, PhD, Chief Scientific and Medical Officer
- Lisa Murdock, Chief Advocacy Officer
Access to Care
Real World Health Care: What are some of the biggest obstacles people with diabetes face in terms of accessing the care they need to manage their diabetes?
Rene Gonzalez
Rene Gonzalez: There are several obstacles and programmatic barriers for people with diabetes in terms of managing their diabetes, especially around diabetes self-management education and support (DSMES). According to the CDC, those barriers include “lack of linguistically or culturally tailored services, curricula, or staff; lack of insurance or insurance with high costs or copayments; lack of family support; competing demands for time and attention; and lack of transportation or childcare.”
From my cultural and linguistic point of view and experience working in the health equity space, I know clinicians would benefit from health equity programming and culturally responsive care. Many times, clinical professionals lack the infrastructure or resources needed for translation and interpretation services. As a result, the undue burden falls on family members to translate or interpret complex and vital medical information in health care settings. Also, for families living in rural communities, access to proper health care is more difficult because leaving work for a doctor’s appointment may take most of the workday just for the commute to their physician’s office. In addition, there are seasonal and harvest requirements throughout the year for rural communities that require time to work on the ranch. For example, in rural eastern Colorado, students are given permission to leave school to focus on the harvest.
RWHC: How are those problems exacerbated by health disparities and socio-economic disparities like food and transportation insecurity?
Rene: Food deserts and easy access to low cost, processed foods such as those found in convenience stores, along with transportation insecurity, are contributing factors when attempting to manage or prevent diabetes resulting from racial and ethnic health disparities. The CDC notes that some racial and ethnic minority groups and groups with lower socioeconomic status have historically had higher rates of illness and death from diabetes than White people, and this gap has not substantially narrowed.
Whether it’s the result of too many empty calories or not enough nutritious ones, research shows that food insecurity in all its forms is a major risk factor for type 2 diabetes. For most Americans experiencing food insecurity, the problem isn’t that they’re getting too few calories, it’s that they’re getting too many of the wrong kind. Usually, the cheapest and most readily available foods (fatty, fried takeout, high-sodium prepared meals, candy, and soft drinks) provide plenty of calories, but they contribute to or make it hard to properly manage chronic conditions such as high blood pressure, kidney disease, and diabetes.
Transportation insecurity for families living in rural and frontier communities is another health disparity facing many families. People in small towns and rural areas, for example, can face long drives to supermarkets with limited stock. In addition, families living in rural communities often have no access to public transportation which makes trips to the supermarket few and far between. To summarize, socio-economic disparities like food and transportation insecurity are intertwined and exacerbated when attempting to manage or prevent diabetes.
RWHC: Are there certain myths about diabetes that add to obstacles patients face?
Robert Gabbay
Robert Gabbay: There is often an unfair negative stigma that places the blame for developing diabetes on poor personal health choices. The fact is, there are many risk factors for type 2 diabetes – some that can be influenced by the individual, but also many that are not. Here are a few of the most common myths we see:
- Diabetes is contagious. There is no way to “catch” diabetes.
- Diabetes is easy. It is in fact like having a master’s degree in nutrition, biology, exercise, etc. It requires a lot of attention to detail.
- Diabetes means you can’t do some things. This is not true. People with diabetes have the same capabilities as anyone else.
- Diabetes happens because you eat too much sugar or too many carbohydrates. This is not true either. There are lots of complicated reasons diabetes happens.
- Diabetes is hereditary. It is sometimes, but not always.
- Insulin causes complications, or insulin causes weight gain. It might seem that way as often people start on insulin at the same time as complications surface, but insulin itself does not cause complications and weight gain. Also, when starting insulin, the body begins absorbing glucose again and there might be some minimal weight gain because of that.
- Prediabetes always leads to diabetes. Prediabetes does not always lead to diabetes. Without treatment, prediabetes could lead to type 2 diabetes.
- People with diabetes need to eat a diabetic diet. There is no such thing as a diabetic diet. People with diabetes need healthy meal patterns, the same as are needed for a healthy heart, cancer prevention, or overall healthy living.
- Taking a lot of diabetes medication means that you are not managing diabetes well. A lot of diabetes medication might be needed to manage diabetes well. Each medication helps to lower blood glucose differently and is needed for a different reason to meet glycemic goals.
- Borderline diabetes is not a diagnosis with diabetes. There is no such thing as “borderline diabetes.” Prediabetes is a medical condition that is now diagnosed when fasting blood glucose is at 100 to 125 mg/dL.
Support For People Living with Diabetes
RWHC: How is the American Diabetes Association helping to address these obstacles and help patients overcome them?
Rene: When it comes to diabetes management, awareness, and prevention, the ADA has a plethora of resources to address obstacles and help support our families and communities. One of ADA’s guiding principles is the Health Equity Bill of Rights which ensures the 122 million Americans living with diabetes and prediabetes, along with the millions more who are at high risk for diabetes – no matter their race, income, zip code, age, education, or gender – get equal access to the most basic of human rights: their health. ADA encourages individuals to visit www.diabetes.org for real-time access to diabetes-related information, resources, community engagement outreach, and opportunities for involvement. For example, individuals can visit our site to find important information such as the recently released 2024 Standards of Care guidelines.
Standards of Care is a set of comprehensive and evidence-based guidelines for managing type 1, type 2, gestational diabetes, and prediabetes based on the latest scientific research and clinical trials. It includes strategies for diagnosing and treating diabetes in both youth and adults, methods to prevent or delay type 2 diabetes and its associated comorbidities like cardiovascular disease (CVD) and obesity, and therapeutic approaches aimed at minimizing complications and enhancing health outcomes.
We also offer tools and resources for caregivers, including our Diabetes Day by Day podcast, which is a great resource for both patients and their caregivers.
RHWC: Diabetes is one of the most expensive chronic diseases in the U.S. How is the American Diabetes Association working to reduce the significant cost burdens patients face in managing diabetes?
Lisa Murdock
Lisa Murdock: The ADA is working to improve access to health insurance and to reduce barriers to care, both in terms of access and affordability, for all Americans with the disease. This includes ensuring all medications people with diabetes need are affordable. The ADA is also working to increase access to technology and services that can improve lives and diabetes outcomes. For instance, the ADA has driven efforts to bring increased access to continuous glucose monitoring (CGM) technology to seniors on Medicare, veterans, and those in state Medicaid programs who have traditionally had less access to the devices. These life-changing devices can improve health outcomes for those with diabetes. ADA is engaged in several other policy efforts to improve access including addressing policies that create barriers like step therapy protocols. Additionally, we are leading efforts to change the trajectory on the rising rates of diabetes-related amputation through policy efforts at both the federal and state levels.
RWHC: How will the recently implemented $35 cap on monthly insulin costs covered under Medicare Part D help to bring costs down?
Lisa: Through advocacy, we are working in partnership with other organizations and elected officials to enact policies capping out-of-pocket costs for those on Medicare and in many state-regulated health plans. These entities provide health care benefits for millions of Americans with diabetes. As a result of political, societal, and marketplace pressures, manufacturers also took action to make their insulin products more affordable in the U.S. While these actions don’t resolve insulin affordability for everyone, they are bringing economic relief to millions. The American Diabetes Association is committed to continuing to work on policy change to bring permanent insulin affordability to all Americans who rely on it to live.