On 14th November this year on World Diabetes Day we witnessed an amazing talk by the keynote speaker Dr. Ronny Bell at the University of Florida. The title of the talk was ‘Challenges and Opportunities in achieving diabetes health equity.’ He spoke about important issues that often get lost and not given too much importance when we talk about diabetes. He mentioned that we all know about the complications, we all know about the emergencies, but what we often don’t talk about it as much as cancer or HIV. He also addressed that diabetes is the most significant public health problem of this generation. Dr. Ronny Bell started his presentation with a quote by Martin Luther King “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” He then informed the audience about the shocking JAMA study which concluded that half of American adults have diabetes.1
Dr. Bell discussed four important factors associated with diabetes ‘common’, ‘debilitating’, ‘costly’ and ‘discriminant’. He mentioned that there was increase in prevalence of diabetes over the last 50 years. Approximately 30.3 million Americans or 9.4% of the US population had diabetes in 2017.2 Although, there has been more awareness of diabetes and increase in treatment options, baby boomers are at high risk.3 In terms of diabetes being debilitating, it is the 5th leading cause of death and responsible for causing various cardiovascular diseases. Diabetes is also a costly disease. The total estimated cost of care for diabetes in 2017 was $327 billion, including $237 billion in direct medical costs and $90 billion in indirect productivity related costs. He further discussed some other risk factors of diabetes namely education, geography (large native American population in Arizona – Pima tribe). Later, he discussed important studies related to diabetes care and the disparities associated.4,5 He emphasized on The SEARCH for Diabetes in Youth Study which reported many racial and ethnic disparities in the treatment and outcomes of T1D in children. According to The SEARCH study, out of the total non-Hispanic white children with T1D, greater than 60% are from families with a household income greater than $50,000 whereas out of the total non-Hispanic black children with T1D, more than a third were from families with a household income less than $25,000.5 Additionally, The SEARCH study also provided evidence that the non-Hispanic white children were more likely to be treated with pumps than non-Hispanic black or Hispanic children (26.3% vs 5.3% vs 12.3%, respectively). This study also provided evidence that the non-Hispanic white children were reported to have more Continuous Glucose Monitoring (CGM) use than non-Hispanic black or Hispanic children. The final part of his speech included information about diabetes prevention programs such as National Diabetes Education Program and Special Diabetes Program for Indians(SDPI). He recommended that steps to living a better quality of life for diabetes patients should include eating healthy, being active, monitoring, taking medicine and healthy coping. He concluded that “diabetes is a major public health problem in the US and worldwide that is common, debilitating, costly and discriminant.” He further added that “Diabetes, particularly Type 2 is a threat to the health of our nation and therefore there is a need to increase awareness for Diabetes and develop strategies to prevent this problem.”
I believe Dr. Bell’s talk resonated with our course contents. Like we discussed in class, he too discussed health disparities and inequalities associated with diabetes care. He mentioned that behavioral risk factors, social determinants, demographic and socioeconomic factors (sex, race and ethnicity, income, education) and spotty health-care access are cause of disparities in United States. Like we discussed in class, he mentioned some fundamental and glaring differences between T1D and T2D. He also discussed an important distinction between Type 1 Diabetes (T1D) and Type 2 Diabetes (T2D) i.e. T1D impacts Non-Hispanic whites the most whereas for T2D, American Indians and Non-Hispanic Blacks are at greater risk. He also emphasized how insurance coverage can greatly improve diabetes patients’ access to care, have an impact on quality of care as well as health outcomes similar to the article Geographic Access to Endocrinologists for Florida’s Publicly Insured Children with Diabetes discussed in class.6 In addition, he explained how racial disparities in insulin treatment methods and diabetes outcomes remain even after adjusting for socioeconomic status similar to the article Racial-Ethnic Disparities in Management and Outcomes Among Children with Type 1 Diabetes discussed in class.7 Dr. Bell also discussed about the Pima and Tohono tribes of southern Arizona and how they have the highest Type 2 diabetes rate in the world. In class we too discussed the “Bad Sugar” episode of Unnatural Causes series which mentioned about these tribes and in detail demonstrated how the change in tribe’s diet due to the diversion of water to white farmers and other cities made the people dependent on government food programs not providing them healthy food options.
Thus, I strongly believe Dr. Ronny Bell’s speech resounded with all concepts discussed in class. Although insulin was discovered long ago, and latest developments have improved lives of patients with diabetes, these advances have not yet discovered a cure to diabetes. Additionally, a lot of money is being spent on the diabetes patients in spite of the availability of new medications and introduction of new technologies. To add to the diabetes care and make certain that the patients have a perfect experience, we as researchers need to document evidences to overcome challenges such as coverage for diabetes medicines and supplies, medication adherence in both T1D and T2D, reduction of over excessive treatment expenses and development of different interventions for pre-diabetes and diabetics to reduce the sufferings of the diabetic patients. Also, the clinicians need to make more patient-centered decisions. Thus, I enjoyed the World Diabetes Day event and hope to attend other similar events in future.
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