By Hannah Edelman
Boston University News Service
Tuesday marks Diabetes Alert Day, the American Diabetes Association’s annual “wake-up call” about the risk of type 2 diabetes. The condition is one of many identified by the Centers for Disease Control and Prevention as a potential cause of severe illness related to COVID-19.
When the COVID-19 vaccination program in Massachusetts first rolled out in December, however, those with underlying medical conditions alone did not qualify for vaccination — including Massachusetts residents with diabetes.
However, many individuals with type 2 diabetes were able to qualify for the phase one vaccine due to their higher rates of reliance on homeless shelters, which fall under the “congregate care settings” criteria.
Studies show that concentrated poverty is a major contributor to the development of type 2 diabetes in the United States. This factor often compounds with race, leading to a higher rate of disease among people of color.
Massachusetts reflects this national trend: as of 2015, Black and Hispanic residents report diabetes rates of 12.3 and 11.7%, respectively, compared to 8.9% of their non-Hispanic white counterparts. The same disparities are evident in the associated mortality rates and frequency of emergency room visits due to the disease.
Chandra Jackson, an investigator at the National Institute of Environmental Health Sciences, explained in an email that these disparities are “essentially the manifestation of historical and contemporary forms of structural racism.”
Jackson said the legacy of discriminatory policies in areas like economics and housing contribute to many of the high-risk factors for type 2 diabetes today. This manifests adversely in environments socially, via the psychological stress caused by poverty. This also manifests adversely in racism and physical means such as access to fresh produce and air pollution exposure.
Despite these larger societal determinants, Merredith Moreau, a nurse practitioner at Joslin Diabetes Center in Boston, said she often sees patients blaming themselves for the disease.
“It’s hard,” Moreau said. “We just need to help patients not only see their barriers, but as healthcare providers, we also need to help them find their resources. If they don’t have them, we need to help develop [these resources] in some way.”
She explained that she offers more frequent check-ins and follow-ups for vulnerable populations, particularly since the onset of the pandemic. Moreau often sees more difficulties in regard to follow-through and overall management of diabetes amongst people of color.
The treatment and assistance of individuals after they have contracted a disease like diabetes is known in public health as a downstream determinant. Overarching systemic risk factors like structural racism are known as upstream determinants. Because of this, epidemiologists like Jackson emphasize the importance of “multi-level, multifactorial interventions.”
One organization dedicated to this type of approach is the Latino Health Insurance Program (LHIP), which serves a community that is 98% low-income. LHIP also speaks Spanish or Portuguese as a first language.
Dr. Milagros Abreu founded LHIP in East Boston in 2006 to increase access to care and health literacy among racial and ethnic minorities, particularly those of Latin descent. The organization now provides outreach, educational resources, health screenings and assistance in enrolling in programs for health insurance and governmental aid.
“It is critical that we identify ways to eliminate these disapirites so we can have healthier people in our community independently of race and or any other diversities and cultures,” Abreu said.
One of LHIP’s focuses is on type 2 diabetes. Abreu emphasized that type 2 diabetes is a preventable condition that often develops out of food insecurity. To address this issue, LHIP helps residents find nearby food pantries and apply for federal nutrition programs like the Supplemental Nutrition Assistance Program (SNAP).
LHIP also offers programs on chronic condition management, prevention and healthy eating. This includes a discussion of the potential comorbidities of untreated type 2 diabetes, such as strokes, heart disease and nerve damage.
“Especially in Massachusetts, we have so many advanced technologies and we have been able to successfully develop so many interventions and medical progress and innovation,” Abreau said. “People are living longer in general. But, there is a vast portion of people, especially those underserved low-income minority residents, who are not meeting the same task.”
These health disparities frequently lead to other compounding disabilities and an overall decrease in longevity. Abreu predicts that, without interventions, this disparity will harm the future workforce. This disparity will be magnified as minority populations continue to grow. Abreu said proactivity and early intervention are crucial to avoid future issues.
“We need to be mindful of these demographic changes across our state and across the country,” Abreu said. “If we learn more about them, we will be able to address these features that are affecting our populations in our future.”
