How neighborhoods shape life with diabetes

(Reuters Health) - - People with diabetes who live in poor communities with limited access to exercise facilities or grocery stores may have a harder time managing their symptoms than diabetics living in more affluent areas, a U.S. study suggests.

A patient takes a blood glucose test during an event aimed to help people with diabetes to cope with their illness at Saint Luka diagnostics medical center in Sofia, November 13, 2012. REUTERS/Stoyan Nenov

Communities with lower employment, income and education that have scant resources to support exercise and healthy eating have long been linked to an increased risk of developing diabetes. For the current study, however, researchers focused on 15,308 patients who already had diabetes to see if their neighborhoods might impact how well they lived with the disease.

At the start of the study, all of the patients had poorly controlled diabetes, based on blood tests that show the percentage of hemoglobin (a molecule on red blood cells) that is coated with sugar. So-called hemoglobin A1c levels reflect average blood sugar levels over about three months. Readings above 6.5 signal diabetes, and everyone in the study had readings of at least 7.5.

Over six months, reductions in A1c were 0.07 percent less in townships with the most socioeconomic deprivation than in the most affluent neighborhoods, the study found.

At the same time, A1c improvements were up to 0.19 percent greater in communities with the most exercise opportunities than in the places with the fewest resources for physical activity. A1c improvements were also 0.10 percent bigger in areas with the best food availability.

“People with type 2 diabetes do not live in their doctors’ offices, and most of the work they do to control their disease, such as eating a healthy diet, exercising, and taking their medications, happens in the communities in which they live,” said lead study author Annemarie Hirsch of the Geisinger Health System in Danville, Pennsylvania.

“If communities do not offer healthy food options or safe places to exercise, it is going to be harder to manage type 2 diabetes,” Hirsch said by email. “Living in neighborhoods with high unemployment and high poverty can also cause stress, and chronic stress has been associated with poorer (blood sugar) control in people with type 2 diabetes.”

Globally, almost one in 10 adults has diabetes, according to the World Health Organization. Most of them have what’s known as type 2 diabetes, which is associated with obesity and aging.

Patients in the current study were 58 years old on average, and most of them were white. Their initial A1c readings averaged 8.2., dangerously elevated blood sugar that can increase the risk of heart attacks, strokes, kidney failure, blindness, amputations and death.

The influence of neighborhoods on A1c was more pronounced in smaller townships, and less apparent or nonexistent in bigger cities, researchers report in Diabetes Care.

The study wasn’t a controlled experiment designed to prove whether or how communities might impact blood sugar in people with diabetes. Another limitation is all the patients were treated at Geisinger, a health system based in Pennsylvania, and the results might be different elsewhere.

“It might be that those with worse pre-existing disease or risk moved to this poorer neighborhood,” said Dr. Rita Hamad, a researcher at the University of California San Francisco who wasn’t involved in the study.

“That means the neighborhood isn’t causing their worse diabetes; they already were at risk because of personal characteristics,” Hamad said by email.

Still, the findings add to the evidence that it can be much harder for patients in poor neighborhoods with limited resources to manage diabetes and other chronic diseases, Hamad said.

Even in bad neighborhoods, people still have options for managing diabetes, added Daniel Lackland, a researcher at the Medical University of South Carolina in Charleston who wasn’t involved in the study.

First off, people should not smoke, Lackland said by email. After that, they should make creative use of the resources that are available.

“For example, if the community is unsafe and there is not access to exercise facilities, walk at shopping malls, parks or public buildings,” Lackland advised. “And for food, read labels and select the healthiest options.”

SOURCE: Diabetes Care, online December 19, 2017.