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 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.
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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: http://bit.ly/2Debto0 Diabetes Care, online December 19,
2017.
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