Challenges + Solutions for Underserved Communities in East Los Angeles
Coverage of the American Diabetes Association (ADA) Scientific Sessions is brought to you by the ADA x BT1 Collab.
This coverage focuses on information shared in the session: “Technology Education in Underserved Populations—Education Factors.” Presenters included:
This session coverage focuses on the information shared by Anne Peters, MD.
People with diabetes living in underserved communities in East Los Angeles (L.A.) face many challenges. Anne Peters shared the adversities this population faces and what can be done to help them gain better, fairer access to care and resources.
Impacts on diabetes care in East Los Angeles
People living in East L.A. face a tough reality that makes managing diabetes effectively difficult. To explain what it’s like to live there while managing diabetes, Peters presented the following data:
- Higher A1c is linked to: public insurance, lower-income, being Hispanic or Black versus Non-Hispanic/White, having no continuous glucose monitor (CGM) and being on multiple daily injections (MDI) versus an insulin pump.
- Social determinants of health include: quality of and access to education and healthcare, economic stability, community and socialization and the environment of someone’s neighborhood or housing.
- People with diabetes living here reported these stressors: having a sick family member, going through a divorce, experiencing the death of a loved one, facing eviction, deportation, or homelessness, losing a job, being a victim of theft or robbery, suffering an injury or abuse, facing legal issues or imprisonment, experiencing food insecurity or having a disability or mental illness.
“High on the list was illness in a family member,” Peters restated. “This is something I see all the time because these aren’t people who have the ability to afford care when somebody they love gets sick. They have to stay home from work—they have to be there helping to take care of their loved one.”
Peters reports that many of her patients are also “terrified of being evicted and are worried about being deported.”
“They don’t want to come to clinics, because they’re afraid they’ll be caught,” Peters said.
Lack of resources + access
Most of Peters’s patients are impacted by one or more of these burdens, overwhelming them and making it difficult to succeed in managing their diabetes.
“We naively say we can help these people with their problems by giving them technology, but what happens when we give them smartphones? The technology and devices get stolen,” Peters says. “These patients work in hard, dangerous jobs. No one is looking out for them. There is a lot of abuse.”
On top of all of this, food insecurity happens in over one-third of Peters’s patients every month. “They don’t have enough money to afford food for themselves or their families,” she says. “Even if they do have the money, it’s not the quality of food we want them to be eating.”
Not being able to speak English also impacts the quality of care people living with diabetes in East L.A. receive.
Peters confirmed this when her colleague, Martha Walker, a multi-lingual diabetes educator, went behind the scenes and called multiple insulin pump companies to find out whether patients could access help when they only spoke Spanish.
Putting language inequality to the test
When calling various insulin pump companies, Walker noticed many similarities in the call center experience. There was the frequent use of interpreter services, but that is not the starkest takeaway.
Peters shared one striking example of Walker’s many experiments:
- Walker called a pump company’s 1-800 number, pretending not to speak English. When she called, the message was in English. She had to wait until the 7th option to hear any Spanish. Then, she was taken to a Spanish menu.
- Walker selected “new pump information.” She was put on hold, and finally a message in English came up and said “Sorry, #224 is not available. You can leave a message.” So, she called again and selected “#1, help with a pump,” and a person answered in English.
- Walker asked to speak with someone in Spanish. They put her on hold for 18 minutes. Occasionally, she heard a Spanish message thanking her for holding. Finally, someone came on the line in English and put her on hold (again) while she got a translator.
- Walker hung up.
This is a call that many of Peters’s patients have to make all the time, and it highlights a need for systemic change.
“There are all sorts of languages spoken all over the United States that make accessing a diabetes company a problem,” Peters concluded.
COVID-19 presented more problems, but also more help
As if there weren’t enough stressors facing this community, the global COVID-19 pandemic presented more problems.
“My little (healthcare) center is at the heart of East Los Angeles, and was at the heart of the COVID-19 pandemic,” Peters says. “I was afraid my patients would all die.”
Thankfully, Insulin for Life helped get CGMs to people in this region for free, which helped until funding ran out.
“As patients got their sensors, they did a bit better, but not enough better. We wanted to get patients on hybrid closed-loop systems,” Peters said.
After facing some uphill battles with Medi-Cal, Peters was finally able to get her patients on hybrid closed-loop systems. This change in access gave her hope that more improvements would come.
Blue Circle Health: a potential solution?
While none of these issues will be solved in a day, Peters says there is hope in the future of Blue Circle Health for underserved communities like those in East L.A. Once it is up and running in Florida, the goal is to bring it to other states, Peters shared.
- Blue Circle Health is known as: “a first-of-its-kind health care delivery system for people with T1D living in underserved communities.”
While Blue Circle Health is focused on people with type 1 diabetes, this could help pave the way for serving people in underserved communities with other types of diabetes. As a patient or healthcare provider, considering all of these issues (and a few potential solutions) can be discouraging, but Peters says her cup is still “half full” because of her inspirational patients.
Peters shared that one of her patients has won two world championships in competitive water sports while living with diabetes. “Somehow, she managed to figure out how to wear a non-waterproof insulin pump while participating in water sports.”
Patients like this help Peters see “what is possible.”
“That’s what I want to do for all of my patients,” she concluded. “Help them see what is possible.”
No one living with diabetes should go without access to the medications and supplies they need to survive. If you are experiencing difficulty affording or accessing your insulin, utilize GetInsulin.org.