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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