Pandemic Complicates Work To Close Health Disparities In Diabetes Outcomes
Typically, the foot traffic in and out of the Wheeler Family Health and Wellness Center on Woodland Avenue in Hartford would be pretty steady.
But since the COVID-19 pandemic hit in March, Keturah Kinch said in-person activity has been a bit quieter.
“We have really taken ahold of offering telemedicine services,” she said. “So, we’ve been engaging with our sickest patients, determining where they are mentally, what are some of their needs.”
Kinch is the site director at Wheeler’s flagship location, which provides a range of primary care and specialty services, including diabetes prevention and management.
Diabetes and prediabetes affect more than 100 million people in the United States. A state report released last month shows that Black and Latino residents have been about twice as likely to be diagnosed with diabetes than non-Hispanic whites.
These two racial and ethnic groups have higher rates of diabetes hospitalization and mortality, too.
That’s why community health center providers say their focus before and during the pandemic has been on reducing these disparities in health outcomes, all the while trying to prevent the coronavirus pandemic from making them worse.
“It is significant that it does affect more so people of color in densely populated areas in urban areas,” Kinch said. “In many respects, the pandemic really just heightened and concentrated some of those already-there issues and barriers that many of our patients face.”
About 80% of patients at Wheeler’s main site in Hartford are Black or Latino, Kinch said.
There are different kinds of diabetes, and Type 2 is the most common. People can still produce the hormone insulin, but the body can’t use it effectively to regulate blood sugar.
Risk factors for developing Type 2 diabetes can include being inactive and overweight, and having poor eating habits.
Many diabetics can successfully manage their diabetes with regular health care visits and a combination of exercise, nutrition and medication. But those who don’t control the chronic disease are more at risk of serious health complications like heart disease, kidney disease, nerve damage and other issues.
Environmental and socioeconomic factors -- everything from air quality and transportation to income and health insurance -- can help or hinder someone’s ability to manage diabetes, especially now in the pandemic.
“Folks are choosing which bill they’re going to pay this month and maybe it’s not a medial bill,” Kinch said. “Or maybe they will not access health services because they’re afraid of receiving a bill.”
Dr. Mellisa Pensa is clinical lead of health equity at Fair Haven Community Health Care in New Haven, which serves a significant population of Latino and low-income residents. She estimates about 20% of patients there have diabetes or prediabetes.
“The challenging thing for us to witness is that there are patients who just, the barriers are so great that even if the desire to engage in their care is there, it can be stifled by these things,” Pensa said. “We see patients who are forgoing food so they can pay for their medications, or forgoing food and medicine so they can pay for rent.”
Pensa said some of her diabetic patients also face language barriers.
“Even though our patients have access to Spanish language services here at Fair Haven, so often we’ll see a patient in follow-up and they’ll say, ‘My medication wasn’t at the pharmacy,’” Pensa said. “You call the pharmacy and they’re like, ‘It’s there, we have refills.’ So, something clearly was lost in translation.”
Health providers say there are also people who have a deep mistrust in the health care system that stems from new or inherited experiences of systemic racism. The centers use community health workers to try to rebuild those relationships.
Fair Haven’s diabetes prevention program has moved many of its services to virtual and remote health care options since the spring. Providers are doing one-on-one care and group services by reaching patients over the phone or through other telemedicine options.
Abmaridel Montosa, diabetic nurse educator at Fair Haven, said an important part of their services has been the bilingual family education program. She said this aims to stop the cycle of multigenerational diabetes, especially in marginalized communities and groups of people.
“So many kids when they’re coming to screening have already some sort of metabolic disorder going on,” Montosa said. “And many of the parents are already either there [with diabetes] or have prediabetes or hypertension and all these things -- look at the disease as a whole family, because everyone needs to be on board and make changes.”
The overall prevalence of diagnosed diabetes among Connecticut adults has remained stable over the last seven years, according to the state report. But nationally, it is steadily rising.