Social Determinants of Poor Management of Type 2 Diabetes Among the Insured
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DIABETES EPIDEMIOLOGY (E SELVIN AND K FOTI, SECTION EDITORS)
Social Determinants of Poor Management of Type 2 Diabetes Among the Insured Minal R. Patel 1 Accepted: 26 October 2020 / Published online: 5 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Even with insurance coverage increasing over time among the population with diabetes, a large proportion continues to have poorly controlled disease. The purpose of this narrative literature review is to describe the social determinants of poor management of type 2 diabetes among the insured population and illustrate drivers of poor outcomes beyond insurance coverage. Recent Findings Despite the provision of health insurance, social determinants play a significant role in shaping diabetes outcomes, especially for economic instability (employment, out-of-pocket expenses associated with diabetes management), food insecurity, education and literacy, access to quality health care (health systems designed to effectively manage chronic disease), neighborhood and the built environment (segregated neighborhoods, socioeconomic conditions of communities, housing), and social and community context (discrimination, social support). Summary Multiple social determinants shape poor diabetes outcomes among the insured. These determinants are now being further exacerbated by the COVID-19 pandemic, which has created the worst economic crisis for US families since the Great Depression. The evidence of this review points to the imperative need for more multilevel intervention approaches to address these determinants in the management of diabetes. Keywords Social determinants . Diabetes . Health insurance . Outcomes
Introduction Diabetes impacts 1 in 10 Americans in the United States (U.S.) and is among the leading causes of death and disability [1]. Diabetes is the leading cause of kidney failure, lower limb amputations, and adult-onset blindness, and the seventh leading cause of death in the U.S. [1–3] The average medical expenditures among people with diagnosed diabetes are 2.3 times higher than what expenditures would be in the absence of diabetes [4]. In 2017, the total cost of diagnosed diabetes in the U.S. was $327 billion, which includes $237 billion in direct medical costs and $90 billion in reduced productivity [4]. Much of these clinical and economic consequences of This article is part of the Topical Collection on Diabetes Epidemiology * Minal R. Patel [email protected] 1
Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Room 3810, Ann Arbor, MI 48109-2029, USA
diabetes can be avoided with effective management of the condition. However, one-third to nearly half of people with diabetes still do not meet general targets for glycemic, blood pressure, or cholesterol control [5]. Health insurance provides protections from significant financial risk associated with the costs of health and medical care. It has been shown to be a strong ind
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