Diabetes among homeless up by 22 per cent
Up to 22 per cent of homeless people around the world have diabetes and many of them struggle to control their condition, new research has shown.
The findings of the systematic review of global research on homelessness and diabetes from 1990-2020 were unveiled at the Diabetes UK Professional Conference (DUKPC) 2021.
Our review has confirmed that internationally, individuals with diabetes experiencing homelessness are at very high risk of adverse health outcomes Dr Catherine Russell
The research, led by Dr Catherine Russell from the NHS Greater Glasgow and Clyde Trust, showed that people experiencing homelessness who had diabetes had poorer blood sugar control compared to the housed population.
Two separate studies reported that more than 40 per cent of those with diabetes had a HbA1c of 64mmol/mol – significantly higher than the 48mmol/mol target for people with diabetes.
In addition, homelessness was also associated with higher rates of recurrent diabetic ketoacidosis (DKA) and higher rates of lower limb amputation. However, diabetic retinopathy was no more prevalent in homeless people than housed people with diabetes.
Diabetes self-management
Barriers identified which prevent 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 Russell 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.”