Diabetes Care Is Community Care

A pharmacist sorts pills and a set of hands use a diabetes blood monitor.

Racial inequalities have driven the disease for decades. Should a national treatment strategy move closer to underserved neighborhoods?

The number of people in the U.S. living with diabetes has almost tripled since 2000,https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf https://www.cdc.gov/diabetes/statistics/slides/long_term_trends.pdf and by 2050, it could affect as many as one in three people in the country.https://www.cdc.gov/media/pressrel/2010/r101022.html#:~:text=The%20report%20predicts%20that%20the,1%20in%205%20by%202050 But that caseload is not distributed evenly. Black adults are especially at risk, and nearly twice as likely as white adults to develop type 2 diabetes.https://www.nih.gov/news-events/nih-research-matters/factors-contributing-higher-incidence-diabetes-black-americans A quick look at other populations with elevated risks — other racial minorities,https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=18#:~:text=In%202016%2C%20non%2DHispanic%20blacks%20were%202.3%20times%20more%20likely,whites%20to%20die%20from%20diabeteshttps://www.cdc.gov/diabetes/library/features/hispanic-diabetes.html as well as people with lower incomeshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4021012/#:~:text=We%20found%20a%20race%E2%80%93poverty,for%20both%20Whites%20and%20Blacks — should be cause for alarm and swift action.

Health risk is tied to neighborhoods and communities,https://www.cdc.gov/nchs/nvss/usaleep/usaleep.html and diabetes is no different. Populations at highest risk for the disease are statistically more likely to live in places without easy access to supermarkets,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102245/ a factor that increases risk, or access to health care providers. In the years ahead, solutions that take place in these same neighborhoods will be key to turning back the tide of disease.

“Diabetes is a problem that requires community-based solutions,” says endocrinologist Kenneth Snow, who has spent more than two decades developing clinical strategies for managing diabetes. He now works with CVS Health on their Transformation Team, which is developing new, locally-based models for care of diabetes and other chronic diseases.

Two key issues will be better access to local care and overall affordability. While community health centers already exist in many Black and brown communities, says Snow, and can deliver some checkups and screening services, more robust solutions can be tougher to find in neighborhoods where traditional health care services are in short supply. The recent spread and rising adoption of retail medical clinicshttps://www.rand.org/pubs/research_briefs/RB9491-2.html and ambulatory care centers,https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/walking-out-of-the-hospital-the-continued-rise-of-ambulatory-care-and-how-to-take-advantage-of-it# which represent one of the fastest growing sectors in health care, may offer those solutions closer to where they’re needed.

Headshot of Daniel Finke

“Our coordinated, community-based approach can help address health disparities.”

Dan Finke, Executive Vice President, CVS Health and President,  Aetna

For instance, many of CVS Health’s MinuteClinic facilities, says Snow, now offer a number of critical services that can help manage diabetes on a walk-in basis. Those include on-site retinal screening, pharmacist consultations and access to guidance — in person or virtually — from Certified Diabetes Educators who can help patients with nutrition and lifestyle. “We know that when you bring care to people, they’re much more likely to access it,” Snow says. Telehealth — more widely embraced since the COVID-19 pandemic beganhttps://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm#:~:text=During%20the%20first%20quarter%20of,the%20same%20period%20in%202019 — can also help deliver care.

Affordability is another important frontier. The high price of insulinhttps://www.rand.org/news/press/2020/10/06.html means that many skip or ration doses — one in four, according to a recent Yale study.https://www.ajmc.com/view/gathering-evidence-on-insulin-rationing-answers-and-future-questionshttps://payorsolutions.cvshealth.com/sites/default/files/cvs-health-payor-solutions-white-paper-understanding-health-disparities-diabetes-november-2020.pdf Insulin costs remain an industry-wide challenge, says Snow, but in some cases, making consumers aware of their options can bring down costs. The vast majority of people with type 2 diabetes who need insulin, for instance, can be treated with less-expensive human insulin, rather than the newer, genetically engineered insulin analogs. Pharmacists can help educate people who could do equally well with either.

Retail points of care can also help with other costs of care, such as missing a half-day of work to visit a physician’s office — a concern for workers with minimal leave or sick days. A retail checkpoint can offer a suite of diabetes services on a drop-in basis, and often at more convenient hours.

Centering diabetes care at a pharmacy can promote a one-stop approach that keeps the patient’s health, convenience and financial concerns front of mind. “Diabetes is a case study in how a more connected experience can translate to simpler, affordable and more accessible care for underserved communities,” says Dan Finke, Executive Vice President, CVS Health and President,  Aetna. “Instead of having a patient navigate through multiple services in different places, our coordinated, community-based approach can help address the health disparities that have too long characterized chronic diseases like diabetes.”

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