Effect of poverty on diabetes prognoses

People who live in poor neighborhoods have an increased risk of developing diabetes and are more likely to suffer from complications from the disease.

Diabetes is a chronic health condition that affects how food is broken down into energy in the body. When the condition is poorly managed, diabetes can lead to more serious health complications such as heart disease, vision loss and kidney disease.

Over 90 percent of people diagnosed with diabetes have Type 2 diabetes, which results from a combination of the inability of the pancreas to produce enough insulin and cell resistance to insulin. A lack of insulin, a hormone that regulates blood sugar levels, in Type 2 diabetic patients, causes dangerously high blood sugar levels.

Type 2 diabetes can develop as a result of obesity or lack of exercise. These factors contribute to high blood sugar levels that impair the pancreatic cells’ ability to secrete insulin.

In neighborhoods of poor housing conditions, a lack of access to fresh produce and green space, such as parks and recreational areas, contribute to the rise in diabetes prevalence.

Food deserts, which are low-income residential areas with limited access to supermarkets and large grocery stores, are commonly found throughout Los Angeles and can lead to food insecurity.

According to the California Health Interview Survey, 44 percent of individuals in

low-income households in Los Angeles face food insecurity.

“Nearly 1 million Los Angeles County residents find it difficult to put food on the table,” said Kayla de la Haye, an assistant professor of population and public health sciences at the Keck School of Medicine of USC.

People who live in food deserts often resort to fast food or convenience stores, which can be more affordable and geographically accessible.

A recent study from the USC Dornsife Public Exchange showed that one in three people experiencing food insecurity had difficulty getting nutritious food because they lacked transportation or because food stores were either closed or had limited hours.

Fresh fruits and vegetables are critical for the maintenance of normal weight and regulation of the body’s stress levels. Inability to properly manage the body’s stress hormone, cortisol, can lead to disease manifestation.

“So we’re basically talking about systematic stress over time, lack of control that eventually leads to higher cortisol levels, among other things,” said Dennis Raphael, a professor at the School of Health Policy and Management at York University.

Raphael said cortisol adversely affects the body’s ability to properly use insulin that is available, which can lead to diabetes.

In addition to the lack of nutritious foods that may contribute to the development of diabetes, black people who live in poor neighborhoods who are diagnosed with diabetes are also less likely to seek and obtain adequate treatment. 

Improper disease management can lead to more serious health consequences such as limb amputations and vision loss. 

According to a study from The Lancet, many African Americans diagnosed with diabetes underwent unnecessary limb amputations due to a lack of disease screening and proper disease management.

“Their health issues likely wouldn’t have gotten as severe had they gotten care earlier,” said Arjun Sinha, associate professor of clinical medicine at the Indiana University School of Medicine.

Sinha said that many patients with end-stage kidney disease caused by diabetes likely could have faced a better outcome if they received treatment sooner.

According to a study from the American Journal of Public Health, there is a social gradient in diabetes risk with people of lower socioeconomic status being at higher risk. 

For African Americans who live in poverty, the prognosis following a diabetes diagnosis is often more severe than for other ethnicities.

Zeb Saeed, an endocrinologist at the Indiana University School of Medicine, said that one’s living environment can not only lead to a diabetes diagnosis but also exacerbate the disease.

While diabetes can usually be well-managed with a nutritious diet, regular exercise and medication, patients who live in poverty and have less access to these resources ultimately face more serious outcomes.

“A lot of this is systemic every step of the way,” Saeed said. “The Black community is falling through the cracks.”