Health Equity and Disability Issues in Diabetes Care #2

Almost 11% of the United States population, or around 37.3 million people, have diabetes, with higher rates among those with lower socioeconomic status or lower levels of education.1 The financial burden of diabetes in 2017 was $327 billion dollars, 72% of which was due to direct medical costs.2 Approximately 1 in 4 health care dollars is spent on diabetes alone.3 Medications for comorbid conditions and inpatient admissions due to diabetes are the largest drivers of high direct medical costs.2 Use of inpatient diabetes teams have been associated with a decreased rate of 30-day hospital readmission, decreased length of hospital stay, and lower hospital costs4,5 but are not readily available at all inpatient facilities. Access to such services is only one example of health inequity in diabetes care. There are also numerous other disparities in diabetes care including prescribing differences, access to care, health insurance variations (eg, Medicaid vs. commercial insurance), and a myriad of other social determinants of health (eg, low health literacy) that can impact diabetes care. The goals of this paper are to define health equity, describe examples of health inequity, and describe solutions that case managers can use when caring for people with diabetes.