Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Room 3810, Ann Arbor, MI, 48109-2029, USA.
Curr Diab Rep. 2020 Nov 5;20(11):67. doi: 10.1007/s11892-020-01354-4.
Even with insurance coverage increasing over time among the population with diabetes, a large proportion continues to have poorly controlled disease. The purpose of this narrative literature review is to describe the social determinants of poor management of type 2 diabetes among the insured population and illustrate drivers of poor outcomes beyond insurance coverage.
Despite the provision of health insurance, social determinants play a significant role in shaping diabetes outcomes, especially for economic instability (employment, out-of-pocket expenses associated with diabetes management), food insecurity, education and literacy, access to quality health care (health systems designed to effectively manage chronic disease), neighborhood and the built environment (segregated neighborhoods, socioeconomic conditions of communities, housing), and social and community context (discrimination, social support). Multiple social determinants shape poor diabetes outcomes among the insured. These determinants are now being further exacerbated by the COVID-19 pandemic, which has created the worst economic crisis for US families since the Great Depression. The evidence of this review points to the imperative need for more multilevel intervention approaches to address these determinants in the management of diabetes.
即使随着时间的推移，糖尿病患者的保险覆盖率不断增加，但仍有很大一部分患者的疾病控制不佳。本综述的目的是描述保险人群中 2 型糖尿病管理不善的社会决定因素，并说明除保险覆盖范围之外导致不良结果的驱动因素。
尽管提供了健康保险，但社会决定因素在塑造糖尿病结果方面起着重要作用，尤其是对于经济不稳定（与糖尿病管理相关的就业、自付费用）、粮食不安全、教育和识字水平、获得高质量医疗保健（旨在有效管理慢性病的卫生系统）、邻里和建筑环境（隔离的邻里、社区的社会经济状况、住房）以及社会和社区环境（歧视、社会支持）。多种社会决定因素影响了保险人群中糖尿病的不良结果。这些决定因素现在因 COVID-19 大流行而进一步恶化，这是自大萧条以来美国家庭遭遇的最严重经济危机。本综述的证据表明，迫切需要采取更多的多层次干预措施来解决这些决定因素，以管理糖尿病。
