The Importance of Health Equity in Diabetes Care

Soon after the American Diabetes Association (ADA) and Genentech, a member of the Roche Group, announced a partnership to improve access to eye disease screening for individuals with diabetes, Chuck Henderson, the CEO of ADA, spoke with Drug Topics about the importance of eye health and overall healthy equity and how pharmacists can help improve equity and diabetes outcomes.

Diabetes is the leading cause of vision loss in individuals 18 to 64 years of age; African Americans, American Indians, Alaska Natives, Hispanics/Latinos, and older adults living with diabetes are at higher risk of losing their vision or going blind, according to the ADA.¹ “Comprehensive eye exams play a crucial role in the prevention, early detection, and intervention of eye disease and vision loss caused by diabetes, yet many in these communities either don’t receive or don’t have appropriate access to eye health care.”

Drug Topics: How important is it for pharmacists—and the entire health care team—to be involved in eye health screenings, particularly for underserved populations?

Chuck Henderson: Racial and ethnic minorities are disproportionately affected by diabetic retinopathy and diabetic macular edema and are more than 2 times as likely to develop significant visual complications from diabetes. African Americans were less likely than non-Hispanic whites to receive any eye care examinations.

That’s why programs like this are so important, to help collectively address systemic inequities. As part of this particular pilot [program] for equitable eye care in the diabetes community, the ADA and Genentech are seeking partners from local health systems to design and execute a program targeting key progress measures for outcomes improvement.

Drug Topics: How important are eye health screenings for those with diabetes?

Henderson: They are crucial. Diabetic eye disease is a leading cause of vision impairment, but it is preventable. Our goal is to empower individuals with diabetes by identifying and removing barriers to eye care that can save their vision. Anyone with diabetes is at risk for diabetes-related eye diseases such as diabetic retinopathy, diabetic macular edema, glaucoma, and cataracts—and that can mean millions of people are at risk.

Drug Topics: Can you provide an update on the ADA's Health Equity Now program? How many patients with diabetes has it helped?

Henderson: The ADA Health Equity Now platform has reached and helped thousands of people with a diabetes diagnosis by disseminating education and awareness resources to improve diabetes care since its inception in 2020. We've strived to meet people where they are and address and remove obstacles to care.

One example includes our focus on reducing health inequities by eliminating barriers to accessing tools and technology to improve diabetes management and quality of life within the African American community within the 43205-zip code [for Columbus, Ohio], where over 12,000 people struggle with access to care [and are living with] chronic diseases and obesity. To achieve this objective, we worked with community-based organizations (CBOs) to help recruit community members and provide them with a free continuous glucose monitoring (CGM) device to help them learn how to manage their diabetes condition; over 100 people with CGMs on their arms and positively changing their lives. We're looking to scale beyond the Columbus community where we started 2 years ago.

Another example includes a partnership with a CBO on the south side of Chicago. We focused on combating systemic disparities for people in Englewood, Cook County, and 25 of the 77 Chicagoland neighborhoods by increasing access to healthy health food and providing diabetes education. More than 613,000 residents in Cook County live in households that have struggled with food insecurity since 2021. To date, over 170,000 lbs of fresh produce are provided at the doorstep of nearly 2100 residents every week, which is the equivalent of 126,473 households have been serving healthy, fresh products.

In addition to the important program initiatives ADA is undertaking, we’re making strides toward our Health Equity Bill of Rights through policy initiatives. The right to access insulin and other drugs affordably is at the top of the ADA’s Health Equity Bill of Rights.

Since 2017, ADA has been driving force to make insulin more affordable working at both the state and federal levels to lower insulin prices for those who rely on it to live. To date, the ADA has led efforts that capped insulin co-payments in 22 states and the District of Columbia and was instrumental in the passage of landmark federal legislation limiting monthly co-payments on insulin for those in Medicare. We also have assistance available for anyone needing help affording insulin at Insulin Help.

ADA has also made great progress in the Right to Medical Advances which includes increasing access to diabetes technology. Health care systems, including Medicare and Medicaid, can have restrictive policies that make accessing diabetes technology—including CGMs—difficult. Furthermore, ADA has found that people of lower income, older people, and those of color have the least access to this life-saving technology. Through our advocacy these barriers have been lessened for those on Medicare and those in some Medicaid programs.

Drug Topics: How can pharmacists get involved in and learn more about Health Equity Now?

Henderson: Pharmacists and other health care professionals can get involved in multiple ways. ADA has a volunteer-led national committee focused on addressing disparities in health care. This active group of clinicians, researchers, and educators meet several times yearly to create action plans to address inequities along the health continuum. Participation is welcomed.

Another way to get involved is by attending the ADA Scientific Sessions. The meeting is an annual convening of global thought leaders who help inform cutting-edge science around diabetes prevention, management, and care. We'll be increasing content around health equity to support healthcare professionals in understanding social drivers and barriers to care and meeting their patients where they are in a meaningful way.

References

1. The American Diabetes Association and Genentech partner to increase equitable access to eye health care. News release. American Diabetes Association March 20, 2023. Accessed March 20, 2023. https://diabetes.org/newsroom/press-releases/2023/american-diabetes-association-genentech-partner-increase-equitable-access-eye-health-care