Homeless facing diabetes crisis

Research reveals homeless people facing diabetes crisis

• New research, presented at DUKPC 2021, finds that globally, up to 22% of people experiencing homelessness have some form of diabetes
• Over 40% of homeless individuals with diabetes have blood sugar levels above healthy range
• People with diabetes who are homeless are at much higher risk of death and serious complications such as amputations

New research presented today at the Diabetes UK Professional Conference (DUKPC) 2021 has revealed the scale of the diabetes crisis among the global homeless population. The review of international research on diabetes and homelessness over the last 30 years revealed that up to 22% of homeless people have diabetes. Homeless people living with diabetes were found to have poorer blood sugar control and higher risk of serious diabetes complications, including amputations and death, compared to the housed population.

Diabetes is a complex condition that must be carefully managed 24 hours a day to reduce the risk of developing serious complications. For people without access to stable housing, diabetes management is difficult. Food availability may be limited, and access to healthcare often provides an additional barrier.

Following a local audit of Glasgow, which highlighted the poor health outcomes experienced by individuals with diabetes in a homeless environment, the team of researchers led by Dr Catherine Russell at NHS Greater Glasgow and Clyde aimed to establish the global scale of the issue.

The team carried out a systematic review of global research on homelessness and diabetes from 1990-2020. Eighteen research papers met the criteria for inclusion in the review: 10 from the USA, three from Canada, and one each from the UK, Ireland, Japan, Germany and New Zealand.

The review revealed that prevalence of diabetes in the homeless population was up to 22% in the US. In England, prevalence was estimated at 4%, however the researchers suggest the actual figure is likely to be higher, as people living with undiagnosed diabetes would not have been counted.

Overall people experiencing homelessness who had diabetes had poorer blood sugar control compared to the housed population, with two studies reporting that over 40% of those with diabetes had a HbA1c (average blood sugar level) of 64mmol/mol – significantly higher than the 48mmol/mol target for people with diabetes.

Homelessness was associated with higher rates of recurrent diabetic ketoacidosis (DKA) – a life-threatening complication of diabetes which requires urgent hospital treatment – and higher rates of lower limb amputation – a result of diabetes-related foot complications. However, diabetic retinopathy was no more prevalent in homeless people than housed people with diabetes.

Barriers to effective diabetes self-management among the homeless population were found to be limited food options and difficulty accessing medications and medical care. People who moved into stable housing were more likely to have HbA1c tests, suggesting better access to diabetes care. Community-based interventions were found to improve overall medication adherence, blood pressure, cholesterol and blood sugar levels.

Dr Catherine Russell at NHS Greater Glasgow and Clyde, said:

“Our review has confirmed that internationally, individuals with diabetes experiencing homelessness are at very high risk of adverse health outcomes. Having robust UK data on homelessness and long-term conditions is vital, and unfortunately we found a concerning lack of data in this area.

“This review demonstrates the urgent need to develop care models and interventions to help improve the care and outcomes for this high-risk vulnerable group.”

 Dr Elizabeth Robertson, Director of Research at Diabetes UK, said:

 “Dr Russell’s research provides a concerning snapshot of the diabetes crisis facing the homeless population. It is vital that homeless people living with diabetes receive the support they need to self-manage the condition and reduce their risk of developing serious complications like foot problems, which can lead to amputation if not treated quickly.

“Being able to self-manage diabetes well requires access to, and regular support from, a diabetes healthcare team. It also relies on a person being able to monitor their blood sugars and manage their diet and medications, and this can be incredibly difficult for people who are homeless who often have limited access to food and medical care.

“More research is urgently needed in the UK to understand how best to support homeless people to live with serious long-term health conditions, such as diabetes, and address the stark health inequalities they face.”

Diabetes occurs when the body either can’t produce enough insulin or it can’t produce any at all, resulting in high blood sugar levels. The condition currently affects 4.8 million people in the UK – around 1 million of whom have undiagnosed type 2 diabetes.

Type 1 diabetes is treated using insulin, which is taken by injection or by using a pump. Type 2 diabetes, the most common type, is usually managed using either insulin, tablets such as metformin, or other injectable medications. People with type 2 diabetes are encouraged to eat a healthy balanced diet and keep active, and for some people, this alone is enough to manage their condition. All types of diabetes require specialist and regular support from a diabetes healthcare team.

Dietary guidance for homeless people with diabetes can be found here: http://www.eehn.co.uk/diabetes-diet-guides-for-homeless-people.html