Material Need Insecurities Associated With Diabetes Control, Healthcare Utilization

Simply increasing access to care is not enough to improve the health of patients with diabetes mellitus as a new study in JAMA has also associated the difficulty of paying for food and medications with poor diabetes control.

Lead author Seth A. Berkowitz, MD, MPH, from Massachusetts General Hospital, and colleagues collected data on more than 400 patients with diabetes in 1 academic primary care clinic, 2 community health centers, and 1 specialty center in Massachusetts from June 2012 to October 2013. They found that 19% of patients reported food insecurity, 27.6% reported cost-related medication underuse, and 39% reported at least 1 material need insecurity. Nearly half (46%) of respondents showed poor diabetes control, which was measured by factors including hemoglobin A1C, low-density lipoprotein cholesterol level, or blood pressure.

“Material need insecurities were common among patients with diabetes mellitus and had varying but generally adverse associations with diabetes control and the use of health care resources,” the authors wrote.

Overall, food insecurity was associated with a greater chance of poor diabetes control and increased outpatient visits. However, food insecurity was not associated with an increase in emergency department (ED)/inpatient visits. In comparison, cost-related medication underuse was associated with increased ED/inpatient visits as well as poor diabetes control.

Having an increasing number of economic insecurities, such as housing instability or trouble paying for utilities in addition to previously mentioned ones, was associated with poor diabetes control and increased healthcare use.

“Health care systems are increasingly accountable for health outcomes that have roots outside of clinical care,” the study’s authors concluded. “Because of this development, strategies that increase access to health care resources might reasonably be coupled with those that address social determinants of health, including material need insecurities. In particular, food insecurity and cost-related medication underuse may be promising targets for real-world management of diabetes mellitus.”