Two recent studies found associations between economic factors and diabetes incidence and control.
In the first study, published by JAMA Internal Medicine on Dec. 29, patients at several Massachusetts clinics were surveyed about unmet basic needs (which the study authors called material need insecurities). These included food insecurity (reported by 19.1%), cost-related medication underuse (27.6%), housing instability (10.7%), and energy insecurity (14.1%). Almost half of the patients had poor diabetes control (HbA1c >9%, LDL >100 mg/dL, or blood pressure >140/90 mm Hg), and the risk of poor control increased with the number of insecurities reported by a patient (odds ratio for each additional need, 1.39). More insecurities were also associated with increased use of both outpatient visits and emergency/inpatient visits. However, no single insecurity was associated with all outcomes, the researchers noted. The findings suggest that targeting these insecurities with multifactorial solutions could improve diabetes care and potentially even health system issues like hospital readmissions. Focusing on specific insecurities, rather than general markers of poverty such as income, could also be useful in individual care, allowing clinicians to direct patients to specific resources, such as food assistance or medication subsidies, the study authors concluded.
The second study, published in Diabetic Medicine on Dec. 30, assessed type 2 diabetes incidence among 7,250 people living in 228 inner-city neighborhoods in Germany. Being male or having a low education level was associated with a higher risk of diabetes (hazard ratios, 1.79 and 1.55, respectively). Living in one of the neighborhoods with the highest unemployment was also independently associated with elevated risk of diabetes (hazard ratio of 1.72 compared to neighborhoods with the least unemployment). A number of factors could contribute to this observation, the study authors noted, including the effects of chronic stress, access to local resources and health-promoting infrastructure, and community norms and social networks that encourage or discourage healthy behaviors.