Over their lifetimes, adults in the United States have a 40% chance of developing type 2 diabetes. And the likelihood for Latino adults is 25% higher. Even worse, Latinos develop type 2 diabetes when younger, and experience more severe complications and higher hospitalizations.
The stark disparities of type 2 diabetes reveal how cultural and social factors affect disadvantaged populations. As a case in point, managing diabetes is more difficult for patients with limited or no ability to read words (low literacy) or count numbers (low numeracy). Distressingly, the U.S. Latino population has lower literacy and numeracy than the national average.
And the COVID-19 pandemic has been brutal for people with diabetes, who account for 40% of COVID deaths in the U.S. It’s no surprise that Latinos, already so susceptible to diabetes, are more likely to die from COVID. This global pandemic has worsened disparities and outcomes from a disease already an epidemic itself.
If we better manage diabetes and address low literacy and numeracy in underserved communities, can both COVID and diabetes have better outcomes?
Consider the “Dulce Digital” study. Published in 2017 in Diabetes Care, an American Diabetes Association (ADA) peer-reviewed medical journal; it showed that delivering treatment information to Latinos and African Americans with diabetes through telephone interventions and text messages produced greater improvement in glucose levels than standard care.
Similarly, our recent randomized, controlled “Tu Salud” study, published in the peer-reviewed ADA journal Diabetes Spectrum, concluded that combining personalized education via digital technology with health care provider intervention helped address barriers to care. Specifically, use of a blood glucose meter and mobile app helped lead to a sustained improvement in glucose control in an underserved Hispanic population with predominately type 2 diabetes, low numeracy, and feelings of being overwhelmed.
We partnered with a community-oriented nonprofit to enroll low-income Latinos with diabetes. More than half had no or only primary school education, resulting in low literacy and numeracy. Notably, 67% reported feeling “overwhelmed” by the demands of diabetes management.
We compared outcomes after 12 weeks in test subjects provided with a blood glucose meter connected to a mobile app versus control subjects who used meters without an app. The meter automatically synchronized data to the app, transmitting to a web-based version accessible 24/7 to health care providers.
The meter screen featured a color range indicator that pointed to green when the reading was in the patient’s personal target range, blue when below, and red when above. Colors augmented the numbers, signaling the status of the glucose value.
Health care providers reviewed the patients’ glucose data in the web app biweekly and texted emojis and brief comments in English and Spanish to patients indicating any needed adjustments in the diabetes care regimen.
Promisingly, patients using the meter and app saw mean blood glucose decrease 11%, number of in-range blood glucose increase 13%, and number of above-range blood glucose decrease 14%.
These studies support the wider adoption and integration of diabetes digital technologies into care protocols.
Underserved populations who are already most at risk for chronic illnesses such as diabetes are often front-line workers, lacking time to see a physician. And simple, widely available technology-enabled interventions, like health management text messages available through mobile phones, can bridge that gap, in turn providing more accessible treatment and outcomes that may also lead to lower costs.
Diabetes uniquely requires patients be experts in their own care and demands 24/7/365 vigilance. Close communication with a health care team eases the burden and improves outcomes.
Glucose management revolves around numbers. Unfortunately, numbers are just noise unless translated into actions. Innovations, such as color for people with low numeracy, are essential for improving outcomes. Alarmingly, 80 million, fully one-fourth of our population, have low literacy and numeracy.
People want to better care for themselves; they just need to be shown how. With a diabetes self-management tool in the palms of their hands, people can use colors to engage and more effectively care for their diabetes.
Society also benefits if health care disparities lessen. When access to care is more equitable, people with diabetes should increasingly see those indicators move from red to green.
Elizabeth Holt is a board-certified endocrinologist.
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