Diabetes

Diabetes is a leading chronic health condition among patients served by federally funded health centers, and the seventh leading cause of death in the US. Over 12% of Latinxs in the US suffer from diabetes, compared to 9.4 percent of the population overall.¹  In addition to a greater prevalence, Latinxs suffer worse outcomes. Latinxs with diabetes are twice as likely to be admitted to a hospital for lower extremity amputations compared to non-Hispanic whites with diabetes, and are three times more likely to have end stage renal disease due to diabetes.²

Among Migrants

While migrant-specific data are not widely available, this background on Latinxs in the United States serves as a proxy; it is likely that migrants, the majority of whom would be classified as a subset of Latinxs, experience even greater rates of disease complications due to occupational, socioeconomic, cultural and political factors. Some of these include:

• Cultural issues, such as language, literacy, medical knowledge, health care practices and beliefs, and dietary practices;
• Poverty, with unreliable transportation, lack of insurance and prescription coverage, inability to buy services and supplies or to modify diets, and substandard housing that may lack refrigeration, privacy, or adequate bath facilities;
• Migration, causing discontinuity of care and unfamiliar health care systems, as well as special needs related to traveling long distances;
• Political considerations associated with immigration status of the patient and family, and work environments that typically do not include benefits, supports and protections such as disability coverage or worker's compensation;
• Work environments that complicate the needs associated with foot care, glucose monitoring, hydration, rest, and self-medication. 

“Juana*, a mobile agricultural worker with diabetes, has rarely left her agricultural worker housing in Upstate New York, because of her inflexible work schedule, her unfamiliarity with the community and her inability to speak English, and her anxiety around recent flare-ups of anti-immigration rhetoric in the community that other agricultural workers spoke about. With little education about her condition, she decided to ration her insulin rather than seek out a local clinic to refill her prescription. Without consistent medication, her diabetes may get out of control and she may end up in the emergency room.”

- Health Network case study

Improving Care, Improving Outcomes, and Reducing Cost

“Care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes.” --American Diabetes Association

A substantial amount of US medical spending is spent serving patients with diabetes. Underserved patients like mobile workers often have trouble accessing care. Without well-patient diabetes visits, outreach programs, and diabetes self-management programs that take into account the limitations and disruptions that migration present, mobile patients may avoid care until health concerns are acute, more costly, and more difficult to treat. Several health center-focused initiatives have shown that proactive well-patient diabetes visits with an integrated care team fend off crisis management. Additionally, comprehensive care aided with culturally and linguistically appropriate group meetings led by Community Health Workers results in lower Hemoglobin A1c numbers.^{4 5}