Nonmedical Interventions For Type 2 Diabetes: Evidence, Actionable Strategies, And Policy Opportunities

Egede, Leonard E.; Walker, Rebekah J.; Linde, Sebastian; Campbell, Jennifer A.; Dawson, Aprill Z.; Williams, Joni S.; Ozieh, Mukoso N.

doi:10.1377/hlthaff.2022.00236

Cited by 16 publications

(17 citation statements)

References 25 publications

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“…However, common sense dictates that obvious problems are to be handled and solved unless the problems persist after a seemingly logical intervention, or an expensive intervention or investment is required to overcome a problem that causes TI. All individuals managing people with diabetes have a duty to overcome TI, be it medical or nonmedical [44]. Doing so is more likely to be successful when carried out in a consistent and personalised manner, according to patients' needs.…”

Section: Discussionmentioning

confidence: 99%

“…When facing a multifactorial condition such as TI, it is logical to intervene as a multidisciplinary team of healthcare professionals with a working system [43] that is dynamic and provides the flexibility to overcome the causes of TI [44]. One systematic review [44] identified studies published up to January 2022 that were conducted in the United States and included adults at risk for or with T2D. The outcomes included HbA1c levels, blood pressure, lipid levels, self-care, and quality of life.…”

Section: Interventions To Overcome Therapeutic Inertiamentioning

confidence: 99%

“…The findings indicated that multicomponent interventions that combined both medical and nonmedical approaches improved clinical outcomes for people with T2D (HbA1c 1.1% lower at a 3-month follow-up). HbA1c levels improved significantly (0.15% to 1.74% lower) with the use of food supplementation with referral and diabetes support, financial incentives with education and skills training, the use of housing relocation with counselling support (4.3% lower DM prevalence after 10 to 15 years of follow-up), and the integration of nonmedical interventions into medical care using the electronic medical record [44]. Multifaceted versus single-faceted interventions in other studies also led to statistically significant improvements in the odds of medication adherence in diabetes care (subgroup analysis: odds ratio, 2.05; 95% confidence interval, 1.62 to 2.60; P=0.010) [45].…”

Section: Interventions To Overcome Therapeutic Inertiamentioning

confidence: 99%

“…In general, the principles of the biopsychosocialspiritual concept of human needs and holistic care apply. Interventions ranging from knowledge provision about the disease and therapies (health literacy), practical skills training, cognitive behavioural therapy for alignment of one's personal belief system, emotional intelligence for better motivation and self-efficacy, psychoeducation to improve mental well-being [54] and nonmedical social interventions [44] could all contribute to therapeutic adherence or lower TI. These interventions are more effective when incorporating a multidimensional approach than when comprising a singular component.…”

Section: Patient Levelmentioning

confidence: 99%

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Overcoming Therapeutic Inertia as the Achilles’ Heel for Improving Suboptimal Diabetes Care: An Integrative Review

Chew¹,

Yusof

Lai

et al. 2023

Endocrinol Metab

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The ultimate purpose of diabetes care is achieving the outcomes that patients regard as important throughout the life course. Despite advances in pharmaceuticals, nutraceuticals, psychoeducational programs, information technologies, and digital health, the levels of treatment target achievement in people with diabetes mellitus (DM) have remained suboptimal. This clinical care of people with DM is highly challenging, complex, costly, and confounded for patients, physicians, and healthcare systems. One key underlying problem is clinical inertia in general and therapeutic inertia (TI) in particular. TI refers to healthcare providers' failure to modify therapy appropriately when treatment goals are not met. TI therefore relates to the prescribing decisions made by healthcare professionals, such as doctors, nurses, and pharmacists. The known causes of TI include factors at the level of the physician (50%), patient (30%), and health system (20%). Although TI is often multifactorial, the literature suggests that 28% of strategies are targeted at multiple levels of causes, 38% at the patient level, 26% at the healthcare professional level, and only 8% at the healthcare system level. The most effective interventions against TI are shorter intervals until revisit appointments and empowering nurses, diabetes educators, and pharmacists to review treatments and modify prescriptions.

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Section: Discussionmentioning

confidence: 99%

Section: Interventions To Overcome Therapeutic Inertiamentioning

confidence: 99%

Section: Interventions To Overcome Therapeutic Inertiamentioning

confidence: 99%

Section: Patient Levelmentioning

confidence: 99%

See 2 more Smart Citations

Overcoming Therapeutic Inertia as the Achilles’ Heel for Improving Suboptimal Diabetes Care: An Integrative Review

Chew¹,

Yusof

Lai

et al. 2023

Endocrinol Metab

View full text Add to dashboard Cite

show abstract

“…Policy level interventions that address health disparities by targeting social and non-medical care should be integrated with medical care based on the expanse of published literature linking social determinants of health to diabetes prevalence and outcomes. In a recent systematic review looking at nonmedical interventions for type 2 diabetes, researchers identified five policy opportunities backed by evidence that target social risk factors and health disparities: 1) the expansion of Medicaid to all states and the inclusion of coverage for food supplementation based on both medical and financial need; 2) ensuring health care access for vulnerable communities by preventing the closure of critical safety net hospitals and clinics due to financial pressures on health systems, such as seen during the COVID-19 pandemic; 3) legislation for new billing practices that protect uninsured patients, particularly those with diabetes that have high medical care needs and need protection from having to delay care due to cost or bankruptcy; 4) labor market policies targeting social mobility and social infrastructure, including increased minimum wage and paid time off; 5) expansion of subsidized housing, housing vouchers, and subsidized employment in areas with high unemployment rates [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between food insecurity and housing instability on quality of care and quality of life in adults with diabetes

et al. 2022

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Objective Examine the relationship between food and housing insecurities, quality of care and quality of life in adults with diabetes using a nationally representative data source. Methods Data from 39,604 adults with diabetes who indicated if they experienced food and/or housing insecurity in the Behavioral Risk Factor Surveillance System (2014, 2015, 2017) was analyzed. Outcomes included quality of care (HbA1c test, eye exam, diabetes education, foot check) and quality of life (general health status, poor physical and mental health days, poor overall health days). Logistic models were run for each quality of care measure and linear models were run for each quality of life measure adjusting for socio-demographics, insurance status, and comorbidity count. Results 35.6% of adults with diabetes reported housing insecurity, 31.8% reported food insecurity, and 23.4% reported both. After adjustment, food and housing insecurity was significantly associated with lower odds of having an eye exam (housing:0.73, 95%CI:0.63,0.85; food:0.78, 95%CI:0.67,0.92; both:0.69, 95%CI:0.59,0.82), worse general health status (housing:-0.06 95%CI:-0.11,-0.01; food:-0.16, 95%CI:-0.21,-0.10; both:-0.14, 95%CI:-0.20,-0.09), and an increased number of poor mental health days (housing:1.73, 95%CI:0.83,2.63; food:2.08, 95%CI:1.16,3.00; both:1.97, 95%CI:1.05,2.90). Food insecurity was also associated with lower odds of receiving diabetes education (0.86, 95%CI:0.74,0.99) and an increased number of poor physical health days (0.95, 95%CI:0.14,1.76). Conclusion Changes to our healthcare delivery system are critical to improving standards of care and quality of life in all populations and may require a shift towards consideration of overlapping social risk factors rather than the siloed approach currently used.

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Social Risk and Clinical Outcomes Among Adults With Type 2 Diabetes

Walker,

Williams,

Linde

et al. 2024

JAMA Netw Open

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ImportanceNo clear process exists for categorizing social risks in a way that informs effective social risk screening and intervention development.ObjectiveTo investigate social risk profiles and associations of those profiles with clinical outcomes in adults with diabetes using latent profile analysis.Design, Setting, and ParticipantsFor this cross-sectional study, a latent profile analysis was conducted using data for adults with type 2 diabetes collected at 2 primary care clinics in the Southeastern US from 2013 to 2014. Data were analyzed from November to December 2023.Main Outcomes and MeasuresParticipants completed validated questionnaires for 26 social risk factors within 5 domains of social determinants of health: socioeconomic, neighborhood, education, food, and social and community context. In addition, participants completed questions that assessed psychological risk and behavioral risk. A 3-step latent profile analysis was used to identify different subgroups within the sample. Profiles were then regressed on outcomes of hemoglobin A1c (HbA1c), blood pressure, and quality of life.ResultsA total of 615 participants (mean [SD] age, 61.3 [10.9] years; 379 men [61.6%]) were included. Five latent class profiles were identified. The lowest risk group had significantly higher mental health–related quality of life compared with a group with higher neighborhood risk (β, 1.11; 95% CI, 0.67 to 1.55). The second group had low economic risk but high neighborhood risk and served as the reference group. The third group had high economic and neighborhood risk and had significantly higher blood pressure (β, 8.08; 95% CI, 2.16 to 14.01) compared with the reference. The fourth group had high psychological and behavioral risks but low socioeconomic and neighborhood risks. This group had significantly higher HbA1c (β, 0.47; 95% CI, 0.01 to 0.92) and lower mental health–related quality of life (β, −1.83; 95% CI, −2.41 to −1.24) compared with the reference. The highest risk group indicated high risk in all domains, had significantly higher HbA1c (β, 1.07; 95% CI, 0.50 to 1.63), and had lower mental health–related quality of life (β, −2.15; 95% CI, −2.87 to −1.42) compared with the reference.Conclusions and RelevanceThese findings suggest that social risk profiles can be identified according to social, psychological, and behavioral risk domains and the health outcome of concern among adults with diabetes. Future work should consider the use of social risk profiles in intervention development and testing.

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Nonmedical Interventions For Type 2 Diabetes: Evidence, Actionable Strategies, And Policy Opportunities

Cited by 16 publications

References 25 publications

Overcoming Therapeutic Inertia as the Achilles’ Heel for Improving Suboptimal Diabetes Care: An Integrative Review

Overcoming Therapeutic Inertia as the Achilles’ Heel for Improving Suboptimal Diabetes Care: An Integrative Review

Relationship between food insecurity and housing instability on quality of care and quality of life in adults with diabetes

Social Risk and Clinical Outcomes Among Adults With Type 2 Diabetes

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