Food and medication insecurity tied to poor diabetes control

People without reliable sources of food and medicine are more likely to have poor control over their diabetes, compared to those without such concerns, according to a new study.

Researchers found the likelihood of a person having poorly controlled diabetes increased by about 39 percent for each of the so-called economic insecurities they reported.

“What we found is that food and medication are a big deal and probably account for the bulk of it, but it doesn’t look like there is any one thing,” said Dr. Seth Berkowitz, the study’s lead author from Massachusetts General Hospital in Boston.

Approximately 29 million Americans - about 9 percent of the U.S. population - have diabetes, according to the Centers for Disease Control and Prevention.

Type 2 is the most common form of diabetes and is often linked to obesity. In type 2 diabetes, the body's cells may be resistant to the hormone insulin, or the body may not make enough of the hormone. Insulin gives blood sugar access to the body's cells to be used as fuel.

There's been speculation that the 2010 Patient Protection and Affordable Care Act – better known as Obamacare – would increase access to healthcare for people with diabetes, Berkowitz and his colleagues write in JAMA Internal Medicine.

People with low incomes may not benefit as much from that increased access, they add, because getting more healthcare services does not mean also having access to food, medications and other items needed to control diabetes.

For the study, the researchers used data collected from June 2012 through October 2013 from 411 people with diabetes at clinics and health centers in Massachusetts.

Massachusetts expanded healthcare access years before the rest of the country.

“I think what we’re looking at in Massachusetts is where the rest of the country will be in a few years,” Berkowitz said.

Most of the participants had insurance, about 46 percent of the participants had uncontrolled diabetes and about 40 percent reported some sort of inability to get food, medicine or other necessities.

Specifically, about 28 percent reported not taking their medicines because they couldn’t afford the drugs. About 14 percent said they couldn’t pay their utility bills, about 20 percent said they didn’t have reliable access to food and about 11 percent said their housing situation wasn’t stable.

Food and medication insecurities were tied to poor control over diabetes, the researchers found.

For example, about 64 percent of those who reported an unstable food supply had uncontrolled diabetes, compared to about 42 percent of those with food security.

While housing and energy insecurities were not tied to worse diabetes control, the study found that people with an overall greater number of insecurities had greater odds of being less in control of their diabetes.

“I think it lets us know that even if we - nationwide - achieve the rate of insurance coverage in Massachusetts, these problems will still likely exist,” Berkowitz said.

He added that the problem is likely beyond the healthcare system to solve, because the new research showed people with these insecurities were visiting their doctors.

“You have people who are seeking care and seeing what they have, but . . . you’re just not getting people what they need to stay healthy,” Berkowitz said.

“This is sort of a policy or system-level issue,” he said. “I don’t think there’s anything in the course of an individual visit that patients or physicians are going to be able to do.”

Berkowitz added, though, that people should let their doctors and healthcare providers know if they are experiencing any of these difficulties.