Successful diabetes interventions that may end global health disparities
Dr. Ashby Walker highlights several international diabetes programs that combat health disparities
Worldwide rates of diabetes are expected to nearly triple over the next two decades to an estimated 1.3 billion people with the condition by 2050.
To address the rapidly expanding disease crisis, a group of experts led by Ashby Walker, Ph.D., an assistant professor in the PHHP department of health services research, management and policy, have authored an article that highlights several international diabetes programs that combat well-documented health disparities in diabetes and lead to positive health outcomes for people living with the disease.
The article is part of a special three-part series on global inequity in diabetes care published in the journal The Lancet.
Dr. Ashby Walker
The article by Walker and colleagues notes that approximately three-quarters of people with diabetes live in low- or middle-income countries and they experience a large discrepancy in healthy life-years lost to diabetes, compared with people with diabetes in high-income countries.
The authors argue that to address diabetes disparities, interventions need to recognize individual patients within a broader social context that considers factors at multiple levels, including the clinical practice environment and health insurance coverage, as well as broader societal issues, such as stigma related to the disease.
Their article features seven diabetes care programs across four continents that have targeted aspects of social context related to root causes of inequity, said Walker, the chair of the American Diabetes Association’s National Health Disparities Committee.
“The programs also share a common theme of having stakeholder-driven initiatives,” Walker said, “they rely on multisector collaboration and many target policy-level change as part of their aims.”
In Milwaukee, efforts have focused on addressing food and financial insecurity, increasing community capacity through partnership building and changing policies that perpetuate racism.
In five sub-Saharan African countries, the Diabetes CarePak program targets diabetes care at the individual, community and policy levels. The program offers critical diabetes supplies as well as education and outreach with input from members of underrepresented groups. Food product labels provide nutritional information to promote healthy food choices.
“We cannot simply focus on individual-level solutions, but rather, we must approach the individual within a larger social and structural context,” Walker said. “Policy-level changes that ensure access to insulin as well as to technologies like continuous glucose monitors must be part of large-scale efforts to promote equity in diabetes. The cost of drugs like insulin and new technologies is a real barrier for medically underserved communities.”
A bill passed in Florida will make the state’s Medicaid beneficiaries eligible for continuous glucose monitors with a provider’s prescription. Without insurance, the monitors cost patients about $1,700 a year.
“This will have tremendous dividends for improving health outcomes and reducing diabetes-related costs associated with complications,” Walker said.
Xanadu Roque, a Project Extension for Community Health Outcomes, or ECHO™️, Diabetes Support Coach, works with a mentee. Led by UF and Stanford University, the Project ECHO Diabetes program empowers primary care providers to deliver best-practice diabetes care to their patients who are underserved.
