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February 29, 2020
Rebecca Butler, LMSW
Socioeconomic Status and Diabetes: Removing Barriers to Improve Outcomes
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• Identify socioeconomic barriers to diabetes care.
• Identify diabetes burnout/distress.
• Identify resources for barriers to diabetes care and burnout.
Objectives
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• Diabetes Care AffordabilityDiabetes technology not available to all
• Two-parent separate householdsMultiple caregivers or few caregivers
• School Nurse Availability• Diabetes Burnout
School embarrassment
• Neglect
Social Factors
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ANY MEDIA – SMALL (i.e. Photography, Pie Charts,
Bar Graphs, Etc.)
Suggested area dimensions:3.5” W x 4.5” H
Font: Calibri, 14pt, White
• Bullet point field – Font: Arial, 24pt, White
• Second level – Font: 20pt• Third level – Font: 18pt
• Fourth level – Font: 16pt
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Socioeconomic Barriers-Daily Cost of Diabetes
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Why is this happening?Only 3 Companies
Control 90% of Global
Insulin Market
Lawsuits Among
Pharmecuetical
Companies
Patents
Politics
Pharm Marketing
Schemes/Incentives to
Physicians
Price Fixing
ANY MEDIA – SMALL
(i.e. Photography, Pie Charts,
Bar Graphs, Etc.)
Suggested area dimensions:
3.5” W x 4.5” H
Font: Calibri, 14pt, White
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Private Insurance until 26 years old
Public Insurance until the month of 19th birthday
Medicaid until month of 19th birthday
CHIP-18 years old
Public foster care
Aged out-was in a CPS approved placement at 18th birthday-25 years old
Transition CPS Youth-not in care and income requirement-until 20 years old
Adopted-was in CPS custody, adopted, 18 years old
Insurance Coverage for Minors in Texas
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Diabetes is Hard on EVERYONE!
• Multiple daily injections
• Multiple BG checks
• Multiple decisions
• Impulse control
• Initiating tasks
• Doing things different than friends
• Speaking up for yourself
• Tolerating pain
• Emotion awareness and regulation
• And more!
Diabetes Burnout
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Burnout is REAL!• Burnout Starter Kit
• Ask people to work really hard• Don’t notice their efforts• Efforts don’t always affect the
desired outcome• Signs of Burnout
• Mood changes• Task avoidance• Strong emotional response
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• This includes YOU!!
• You worry, struggle, feel helpless• You try your best and child/parent still struggles
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Behavior is the Foundation of Diabetes Management
AND
Diabetes is impacted by other factors than behavior
How to help?
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Change our Language
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Advocacy
• https://rightcarealliance.org/actions/insulin/
• American Diabetes Association-legislative campaign
• Prescription assistance programs• Pending lawsuit against 3 pharmaceutical companies
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• Social Determinants for Recurrent Diabetic Ketoacidosis in Children with Diabetes-Journal of Pediatric Nursing, 2012.
• Recurrent Diabetic Ketoacidosis in Inner-City Minority Patients-Diabetes Care, 2011
• Diabetic Ketoacidosis in Infants, Children, and Adolescents-- Diabetes Care, 2006
• Health Care Utilization and Burden of Diabetic Ketoacidosis in the U.S. Over the Past Decade: A Nationwide Analysis—Diabetes Care, May 2018
• https://www.t1international.com/blog/2019/01/20/why-insulin-so-expensive/
• Dickinson, J.K., Guzman, S.J., Maryniuk, M.D., O’Brian, C.A., et al. (2017). The use of language in diabetes care and education. Diabetes Care, 40: 1790-1799.
Resources