For people with diabetes, effectively managing the condition means addressing numerous aspects of your health and well-being — from what you eat to your physical activity, blood pressure, cholesterol and triglyceride levels, and of course blood glucose levels. It can be a tricky balancing act, no matter what type of diabetes you have or how long you’ve had it.
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But some people with diabetes in the United States are at a further disadvantage due to their financial and social status. Without health insurance that covers diabetes-related expenses in a meaningful way, many people are forced to decide between diabetes drugs or supplies and other necessary living expenses — and will sometimes go without prescribed treatments or other important aspects of self-management.
In recognition of the fact that not everyone with diabetes has access to the same treatments or care, the American Diabetes Association (ADA) — which sets the definitive standards for diabetes treatment in the United States — has added guidance on addressing financial and social hardship to its 2021 standards.
Guidelines recommend assessing access to food, housing and more
In its new Standards of Medical Care in Diabetes — 2021, the ADA urges doctors to assess people with diabetes for food or housing insecurity, access to social support, and “cost-related medication nonadherence,” all of which are well known to make diabetes management much more difficult. Doctors are encouraged to refer people experiencing financial or social hardship to relevant resources in the community.
As noted in a Medscape article on the new standards, the new recommendations for assessing hardship aren’t simply arbitrary. They’re based on careful consideration of evidence on the topic, and follow earlier statements and articles published in July 2020 and November 2020 in the ADA’s journal Diabetes Care. The July 2020 statement was endorsed by a number of other medical societies.
The new standards suggest screening tools, such as questionnaires, that doctors can use to help determine if a patient is experiencing hardship that may interfere with effective treatment of diabetes. But doctors are urged to have conversations on this topic even if they don’t explicitly use a questionnaire, as part of their normal interaction during appointments.
Addressing barriers to treatment and education
One of the keys to effective diabetes self-management is diabetes education, and the new guidelines recognize that barriers to effective education exist — not just financial constraints, but also limited physical access to education in remote areas, and differences in learning ability that make it more difficult for some people to adopt certain behaviors or routines.
Apart from finances and learning ability, the guidelines recognize that psychological and social factors can affect how likely someone is to adopt self-management behaviors. For this reason, they recommend that doctors ask questions to assess patients’ attitudes about their diabetes, their expectations about what treatment and self-care will achieve, and whether patients have social support from friends and family to help with their diabetes management.
As part of considering the psychological and social factors that often determine self-management behaviors, doctors are encouraged to avoid using certain words and phrases that imply judgment and may increase feelings of shame or guilt — and to instead use positive, strength-building language about diabetes management and self-care. They should also consider screening patients for diabetes-related distress, depression, anxiety, eating disorders and cognitive challenges or impairment, depending on the patient’s characteristics.
For people with limited access to diabetes education because of mobility concerns or physical remoteness from services, the new guidelines suggest that telemedicine may play a role in delivering education. To this end, the ADA encourages third-party payers — that is, health insurance companies and government agencies — to offer reimbursement for online or phone-based versions of diabetes education, which not all providers currently cover. But many providers have recently changed their reimbursement policies for telehealth due to the COVID-19 pandemic, and the ADA urges these more flexible policies to remain in place.
Want to learn more about saving on your diabetes care? Read “Save Money on Medicines,” “Stay Healthy On a Budget” and “Do’s and Don’t’s for Saving Money With Diabetes.”