Diabetes & COVID-19: Addressing Health Disparities Through Educational Outreach

July 23, 2020 Ellen Harrison

Diabetes is a common health condition among Americans. The Centers for Disease Control and Prevention (CDC) estimates that 34.2 million people in the United States have diabetes and as many as 7.3 million of those individuals are undiagnosed. In addition, experts believe that 88 million Americans over the age of 18 have prediabetes.

These statistics represented a serious public health issue even before the COVID-19 pandemic. Introduce the novel coronavirus and the picture becomes more concerning. COVID-19 has significantly increased health concerns for people with underlying chronic conditions, and of course diabetes makes up a significant portion of chronic disease for our populations.

The CDC recently shared research based on over 7,000 cases U.S. cases of COVID-19. This study found that Americans with chronic medical conditions face an increased risk of severe illness from the novel coronavirus. Key findings included the following:

  • Among people hospitalized for COVID-19, 71 percent had at least one underlying condition.
  • Among individuals admitted to the ICU, around 78 percent had at least one underlying condition.
  • The most commonly reported conditions among people sick with COVID-19 were diabetes, lung disease and heart disease.

Minorities are at Higher Risk of Both Diabetes and More Severe Cases of COVID-19

The impact of diabetes and COVID-19 is even more dire for black, indigenous and people of color. Research has proven that the prevalence of diabetes varies by race and ethnic group. The American Diabetes Association reports that the rates of diagnosed diabetes are higher among Hispanics (12.5%) and non-Hispanic black individuals (11.7%) than among non-Hispanic whites (7.5%).

Not only are black, indigenous and people of color more likely to have diabetes, they are more likely to be hospitalized for COVID-19. CDC data as of June 12, 2020 revealed that non-Hispanic black individuals have hospitalization rates approximately five times that of non-Hispanic whites. In addition, Hispanic or Latino people have hospitalization rates around four times that of non-Hispanic whites.

Minorities are also more likely to have jobs that are classified as “essential.” The CDC has noted that members of some racial and ethnic minority groups are more likely to work in essential roles that increase the risk of contracting COVID-19, such as in healthcare settings, meat-packing plants, grocery stores or factories. Even when COVID-19 outbreaks occur in the community or workplace, many feel compelled to continue working due to economic need and/or a lack of paid sick leave.

The COVID-19 Risk Landscape Looks Different for People with Diabetes

The CDC recently analyzed data from January 22 through May 30, 2020 and discovered that individuals with underlying health conditions face serious complications and increased mortality rates if they contract COVID-19. The CDC data revealed that nearly one third (32%) of people with COVID-19 had heart disease, nearly one third (30%) had diabetes and 18% had chronic lung disease.

Key insights from this research include:

  • The risk of hospitalization can’t be ignored. Individuals with heart disease and diabetes who contracted COVID-19 were hospitalized six times more often than their healthy peers.
  • Youth isn’t protective, if you have an underlying health condition like diabetes. People in their 20s and 30s with underlying health conditions were also six times as likely to be hospitalized as their healthy counterparts.
  • Higher mortality rates are a reality. People with underlying health conditions died 12 times as often from COVID-19 as healthy individuals.

Diabetes weakens the immune system. As a result, when people with diabetes contract COVID-19 or any other viral infection, it’s often harder for their bodies to fight the virus and recovery can take longer. In addition, COVID-19 seems to thrive in environments where blood glucose levels are high.

While people with diabetes must be aware of these risks, they should also understand that well-controlled blood sugar levels play an important role in improving COVID-19 outcomes. A new study found that people with diabetes with well-controlled blood glucose fared better than people with poorly controlled glucose who contracted COVID-19. These individuals required fewer interventions like supplemental oxygen or use of a ventilator. Overall, they had fewer health complications and were less likely to die from the novel coronavirus.

Targeted Outreach Can Prevent Problems Before They Arise

COVID-19 doesn’t show signs of going away anytime soon. New surges in infections have emerged in several states and experts are uncertain whether a “second wave” will hit the country in the fall coincidental with the seasonal flu.

As we wait for a COVID-19 vaccine to be developed, continued member outreach is one of the best ways to educate at-risk populations about the measures they can take to minimize the likelihood of contracting the virus and to reduce the severity of complications if they do become sick.

Perhaps most importantly, healthcare organizations should leverage predictive and prescriptive analytics across their population to identify those with hidden and rising risk for diabetes and/or prediabetes. Consider deploying a health engagement program with multiple campaign touchpoints designed specifically for the target population you’re trying to reach. By arresting risk progression in the diabetes population, it’s possible to get ahead of issues before they become critical and more costly in the future.

Here are a few things to keep in mind when launching health engagement and outreach programs:

  • Clearly convey the risks of COVID-19 for diabetes populations. It’s important for individuals with diabetes to take extra precautions to avoid contracting the novel coronavirus. This means continuing to wear a mask, engaging in sensible social distancing whenever possible when leaving the house and washing one’s hands frequently. In addition, folks with underlying chronic health conditions like diabetes should focus more on staying healthy, eating healthy foods, getting adequate sleep and continuing to exercise. It’s more important than ever for people with diabetes to keep their blood sugar under control through medication adherence and other forms of condition management. If members need guidance from their physicians and health providers, encourage telehealth visits wherever available as a good alternative to visiting the doctor’s office in person.
  • Communicate to members that they must prepare in advance for another wave of COVID-19. Despite precautions, some people with diabetes may still become sick with the virus. Health plans should frequently remind members that managing blood glucose levels is essential, even if they contract COVID-19. Not every person with diabetes who contracts the virus will need hospitalization. As a result, it’s important to be prepared for recovering at home for a few weeks. This means having an adequate supply of diabetes medication, food on hand and access to drinking water. Infections tend to raise glucose levels which can result in diabetic complications. Patients with diabetes that develop COVID-19 symptoms should consult with their physicians early and often.
  • Highlight the importance of ongoing preventive care. The COVID-19 pandemic has upended many routines, but health plans must communicate the importance of preventive care to all members. These visits may include vision checkups and other screenings for people with diabetes. Members with prediabetes should also resume regular appointments with their primary care physicians. If a member has shifted from prediabetes status to full-blown diabetic symptoms, he or she must begin a diabetes management program. By keeping up with routine preventive care appointments, members can reduce the risk of unanticipated complications if they contract COVID-19.
  • Educate and remind members about available telehealth options. Telehealth has the potential to address several barriers to care for the socioeconomically disadvantaged and other vulnerable populations, for whom access to in-person care may not be viable. Individuals with diabetes shouldn’t let routine monitoring of HbA1c levels, annual retinal eye exams and monitoring of kidney function fall by the wayside. While lab work will need to be done onsite at a healthcare facility, be sure to reinforce the message that telehealth appointments are a viable option for check-ins with physicians. With Medicare now reimbursing telehealth services at the same rate as in-person office visits, make sure your members with diabetes know about their options to receive telehealth services by incorporating this information into your targeted outreach programs.

There are a variety of ways that health plans can target, create and monitor health outreach programs.  Many leading organizations use HMS’ Population Health Management solution to identify, engage and care for high and rising risk populations. If you need help increasing in the health of your population, while improving member satisfaction and lowering costs during this challenging time, we’d be happy to assist.


Have you heard? We’re getting personal about population health.

To learn more about HMS’ Population Health Management solution portfolio, visit our website and schedule a conversation with the experts who are helping healthy happen every day.

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