Homelessness and Diabetes: Reducing Disparities in Diabetes Care Through Innovations and Partnerships

Objective: Homelessness is a growing problem in Canada. Despite poor health and high levels of need, the homeless frequently encounter complex barriers to healthcare services. In particular, long-life management of diabetes is challenging due to complex obstacles. In 2008 to 2010, Alberta Health Services-Calgary, in partnership with the Calgary Drop-In and Rehab Centre developed an innovative diabetes initiative for the homeless. The main objective was to engage the homeless and the community in identifying barriers and effective approaches for improving access of the homeless to diabetes programs. Method: The project provided innovative and accessible diabetes awareness, detection, prevention and management programs. Case management and group interventions were provided by a multidisciplinary team at a homeless shelter where the homeless congregate and reside. Results: The commonly reported barriers to diabetes management relate to diet and limited access to medications, glucose monitoring supplies and primary care providers. Among 524 screening participants, 9% to 11% had pre-existing diabetes, 16% had high capillary blood glucose (CBG) levels (defined as either nonfasting CBG >= 8.0 mmol/L or fasting CBG of similar to 6.0 mmol/L). Among shelter screening participants (n=195), 70% had 1 to 3 risk factors and 22% had 4 or more risk factors for diabetes, 61% were over age 40, 40% had a family history of diabetes, 33% had an elevated waist circumference, 26% were inactive and 26% reported being of Aboriginal, Asian, African or Hispanic descent. Baseline and 3 to 12 month follow-up glycated hemoglobin (A1C) and fasting blood glucose (FBG) results were available for only 10 patients with pre-existing diabetes due to the challenges associated with transportation and FBG testing at shelters. Despite the low follow-up data, mean reductions in FBG of 4 mmol/L and A1C of 1.1% is significant particularly in this uniquely challenged population. Conclusions: Diabetes is a social and holistic disease among the homeless and is seen as an added challenge to the "whole-person's" daily life. Effective diabetes care for addressing multifaceted challenges of the homeless need to incorporate an understanding of the social determinants of health and build on community partnerships and equitable access. (C) 2012 Canadian Diabetes Association