Diabetes Care and Health Disparities Assignment

Diabetes Care and Health Disparities Assignment

Diabetes is a chronic health condition that affects how the body produces insulin or uses the insulin produced (CDC, n.d.). The condition is characterized by uncontrolled or unregulated glucose levels in the body, causing severe complications, especially if not well treated and managed. According to the World Health Organization (WHO, n.d.), diabetes is a condition of national, regional, and global focus in terms of the accessibility of care, care quality, costs related to treatment and complications, and support of positive healthcare outcomes, and impact of the condition on individuals’ lifestyle. This essay discusses the scope of diabetes care as the problem by analyzing its impact, the stakeholders, ethical dilemmas, and the cultural diversity relevance and disparities issues, and explores the policy-based solutions and the effectiveness of the existing policy in relation to the issue. Furthermore, the paper will present the ANA code of ethics that is most applicable to the issue of health disparities in diabetes care.

Scope of the Problem

As mentioned earlier, diabetes is a global issue. The condition encompasses a range of health, economic, and social impacts on individuals. The condition also has a considerable impact on healthcare systems, populations, and societies on a global scale. According to Thong et al. (2020), diabetes care is the most expensive in the healthcare system due to high expenses related to medications, lifestyle changes, hospitalizations, management of complications, and loss of productivity. In addition, there are profound disparities in access to diabetes care services, education, and resources, which significantly contribute to differences in diabetes prevalence and healthcare outcomes. Studies show that individuals from low socioeconomic backgrounds have a higher prevalence of diabetes and an increased rate of complications compared to individuals from well-doing economic backgrounds (Clements et al., 2020). Therefore, diabetes care should aim at ensuring the equitability of resources and interventions for the treatment and management of the condition.

The Impact of Diabetes Care Disparities on the Public

Diabetes affects different populations disproportionately, leading to the issue of health disparities in care. Disparities are usually in the lines of socioeconomic status, ethnic or racial groups, and individuals living in developing countries. As mentioned earlier, the disparities in diabetes care considerably impact the access to care services, patient education, and resources set aside to care for diabetes prevention and management interventions. As a result, there is an apparent disparity in diabetes prevalence and healthcare outcomes. According to the World Health Organization (n.d.), the prevalence of diabetes globally is approximately 422 million, and the prevalence has been rising more rapidly in low and middle-income countries than in high-income countries. Therefore, the impact of diabetes is more felt among individuals and groups who bear a disproportionate burden of the condition.

The impact includes an increased risk of different health complications, such as cardiovascular diseases, kidney failure, loss of eyesight due to retinopathy, and lower limb amputations following diabetes neuropathy. Additionally, Thong et al. (2020) note that populations that bear a disproportionate burden of diabetes also have an increased economic burden since they have to cover the costs related to diabetes care expenses. However, some of these individuals may be unable to pay for the care costs due to loss of income and lack of insurance, thus leading to complications. More so, if the complications are not treated and managed effectively and on time, they can lead to death. The WHO (n.d.) also notes that diabetes contributes to 13% of the total mortality rates globally, with a higher proportion from low and middle-income countries and communities with low socioeconomic backgrounds.

Stakeholders Identification

Various stakeholders are relevant in addressing the issue of diabetes and other challenges posed by diabetes. These stakeholders entail the people who affect the different aspects of diabetes prevention, treatment and management, research, and policy development. The key stakeholders in diabetes include healthcare professionals, diabetic patients, the healthcare systems, insurance payers/companies, government agencies, and public health organizations (Bean et al., 2020). Healthcare professionals are among the key stakeholders in diabetes care since they treat and walk together with the patients in the journey to managing diabetes appropriately and preventing complications. The healthcare professionals who participate actively in diabetes care include endocrinologists and general physicians, nurses, nutritionists and dietitians, and pharmacists.

People diagnosed with diabetes are also primary stakeholders in diabetes care, considering they are actively involved in the management of the condition. In addition, they contribute to their diabetes health outcomes through adherence to treatment plans and lifestyle modifications. The healthcare system also plays a crucial role in diabetes care by offering care services in hospitals and clinics. Bean et al. (2020) note that the healthcare system also contributes to diabetes prevention and management through public awareness campaigns, education, and other health promotion initiatives.

The other relevant stakeholders in diabetes care are insurance payers/companies. According to Delevry et al. (2021), insurance payers provide coverage for diabetes-related services, medications, and management devices, thus improving care access and affordability. Moreover, government agencies and public health organizations such as WHO and CDC develop global strategies and guidelines for diabetes prevention, treatment, and management. These stakeholders also offer funds for research and medical trials meant to develop practice guidelines and improve the quality and outcomes while reducing disparities in diabetes care.

Ethical Dilemmas

Various ethical dilemmas exist in diabetes care. Studies show that the dilemmas in diabetes care and disparities mainly arise from the complex issues involving access to diabetes care, availability of resources, and the affordability of medications. There is a significant challenge in ensuring equitable access to diabetes care services due to financial barriers from the healthcare system and the individuals (Phutke et al., 2020). As mentioned earlier, diabetes is the most expensive condition to treat and manage. Hence, the cost of lifesaving diabetes medications and insulin is high. In contrast, many diabetic patients face financial constraints, a huge dilemma since they need the medications, yet the healthcare system needs the funds to be able to provide these medications. There is also a dilemma in the limited healthcare resources allocated for diabetes care. Resource constraints lead to challenges that may force healthcare systems to select some interventions/treatments and leave out some, thus limiting access to comprehensive care.

Disparity Issues in Diabetes Care

Different disparity issues exist in diabetes care, leading to a disproportionate burden of the disease among different populations. First, screening and diagnosis are an area of disparity since differences are seen in healthcare access based on the determinants of health awareness on the importance of early screening. The disparity leads to unequal and delayed screening among some populations, which may lead to diabetes complications or even death. Secondly, there is a disparity in digital health and technology use in diabetes management and treatment. For instance, technological devices such as continuous glucose monitors are not accessible to all diabetic patients, hence creating a digital divide.

Specific Policy-Based Solutions

One of the current policy solutions aimed at addressing health disparities in diabetes care is the Affordable Care Act (ACA), which was signed into law in 2010. According to ElSayed et al. (2023), the ACA has provisions aimed at improving access to care, especially for minority populations who face healthcare disparities, including disparities related to diabetes care. Among these provisions are Medicaid expansion, preventive services without cost-sharing, health insurance marketplaces, and community health centers. The ACA allows states to expand Medicaid eligibility, thus providing coverage to low-income individuals as a way of increasing access to healthcare services. These services include diabetes screening, preventive care, and treatment/management for insured individuals.

Furthermore, the ACA mandates diabetes preventive care services to be covered by insurance without cost-sharing with the patient. ElSayed et al. (2023) note that these preventive services include diabetes screening for high-risk patients. Considering minority populations are enabled to be eligible for medical insurance, this policy addresses diabetes care disparities by increasing access to preventive care, thus promoting early detection and management. The American Diabetes Association (2021) supports the role of the ACA in addressing disparities in diabetes care since the policy increases access to affordable insurance plans, thus improving their ability to manage diabetes. In addition, the policy has provisions for increasing funds for community health centers that serve underserved populations and provide services to communities with limited access to care, thus reducing diabetes disparities.

The Scope of Disparities in Diabetes Care and Specialty Groups Involved

            The issue of disparities in diabetes care involves different government levels in the U.S. and is also a significant health concern in the global field. Since the different states have different policy provisions for healthcare insurance and access to diabetes care services, the issue involves the federal government level. In addition, the national level is involved in the issue of addressing diabetes care disparities since government agencies, such as the Centers for Medicare and Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC), are directly involved. These agencies are involved in diabetes care research and programs aimed at reducing diabetes care disparities and improving access to healthcare services.

Furthermore, the American Diabetes Association (ADA) is one of the primary specialty groups directly involved in addressing the issue of diabetes care disparities among minority populations. The ADA specialty group aims to improve care and promote health in populations by recommending clinical practice guidelines. It suggests approaches to improve diabetes care quality and access, with the overall goal of improving diabetes care outcomes across populations (ADA, 2021).

Policy Effectiveness and ANA Code of Ethics

            In my opinion, the ACA policy has been significantly effective in addressing the issue of diabetes care disparities. The policy provided access to health insurance to members of minority populations, which mainly face diabetes care disparities, thus enabling them to access diabetes care services, including preventive and treatment/management. However, I believe we still have a long way to go. I would recommend addressing the issue from the root causes, including racism and discrimination in offering diabetes care services.

The American Nurses Association (ANA) has a code of ethics for nurses, serving as a guide to ethical nursing practice. The code outlines fundamental principles and values that nurses should uphold while conducting professional roles. One of the ANA code of ethics provisions applicable to the issue of disparities in diabetes care and the ACA policy solution is provision 8, which states that the nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs (McNeill et al., 2020). In this case, the nurses can collaborate with other professional organizations and government agencies to address the issue of disparities in diabetes care by advocating for policy change and proposing new policy developments to address the issue.

Conclusion

Disparities in diabetes care are an issue that significantly affects access, costs relating to treatment and management, and healthcare outcomes. The evidence presented above has justified the scope of the problem and the impact it has on minority populations. Additionally, the stakeholders identified above play a crucial role in addressing the issue. Due to the ethical dilemmas and related disparity issues, policy-based solutions are best suited to address the issue. The ACA has been effective in addressing the issue by increasing access to diabetes care services through insurance marketplace regulations, access to preventive care, and community health services. The ADA is actively involved in addressing the issue. Nurses are obligated through the ANA code of ethics to collaborate with other organizations in addressing health needs.

References

American Diabetes Association. (2021). 1. Improving care and promoting health in populations: Standards of Medical Care in Diabetes—2021. Diabetes Care, 44(Supplement_1), S7-S14. https://doi.org/10.2337/dc21-S001

Bean, C., Sewell, K., & Jung, M. E. (2020). A winning combination: Collaborating with stakeholders throughout the process of planning and implementing a type 2 diabetes prevention programme in the community. Health & Social Care in the Community, 28(2), 681–689. https://doi.org/10.1111/hsc.12902

Centers for Disease Control and Prevention. (n.d.) What is Diabetes? Accessed on 3^rd February 2024 from https://www.cdc.gov/diabetes/basics/diabetes.html

Clements, J. M., West, B. T., Yaker, Z., Lauinger, B., McCullers, D., Haubert, J., Tahboub, M. A., & Everett, G. J. (2020). Disparities in diabetes-related multiple chronic conditions and mortality: The influence of race. Diabetes Research and Clinical Practice, 159, 107984. https://doi.org/10.1016/j.diabres.2019.107984

Delevry, D., Ho, A., & Le, Q. A. (2021). Association between processes of diabetes care and health care utilization in patients with diabetes: Evidence from a nationally representative US sample. Journal of Diabetes, 13(1), 78–88. https://doi.org/10.1111/1753-0407.13109

ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C. and Gabbay, R. A. on behalf of the American Diabetes Association (2023). 1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2023. Diabetes Care, 46(Supple 1), S10–S18. https://doi.org/10.2337/dc23-S001

McNeill, C., Alfred, D., Nash, T., Chilton, J., & Swanson, M. S. (2020). Characterization of nurses’ duty to care and willingness to report. Nursing Ethics, 27(2), 348–359. https://doi.org/10.1177/0969733019846645

Phutke, G., Patil, S., & Jain, Y. (2020). Ethical qualms while treating diabetes in low-resource areas. Indian Journal of Medical Ethics, (1), 49-53. https://doi.org/10.20529/ijme.2020.019

Thong, E. P., Codner, E., Laven, J. S. E., & Teede, H. (2020). Diabetes: a metabolic and reproductive disorder in women. The Lancet. Diabetes & Endocrinology, 8(2), 134–149. https://doi.org/10.1016/S2213-8587(19)30345-6

World Health Organization. (n.d.). Diabetes, Key Facts. Accessed 3^rd February 2024 from https://www.who.int/news-room/fact-sheets/detail/diabetes

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Directions:

Write a scholarly paper, no fewer than six pages excluding the title page and references, and include the following:

1. Select a current health care issue or problem that represents an ethical dilemma or health disparity (see criteria and suggestions for topic/issue selection) that includes a regional, national and global focus.
2. Identify the scope of the problem
   1. How does the problem or issue impact the public or /population/ or disenfranchised segment of a community? Use state, federal and global data/statistics if available
   2. Identify stakeholders
   3. Identify the ethical dilemmas
   4. Identify any cultural diversity relevance or disparities issues
3. Specify policy- based solutions
   1. Is there a current policy that addresses this problem/issue
   2. Include evidence/ science on why this policy is helpful or why one is needed
   3. What level(s) of US government and global agencies does your issue involve?
   4. What level of government and specialty group (e.g., ANA, AMA etc…) are your immediate targets?
   5. If there is no current policy that addresses the problem/issue, should a policy be developed? Who should lead the policy development? What policy solution(s) should be initiated? Include evidence to support this policy development.
4. Offer your opinion of the effectiveness of the existing policy or proposed policy solutions related to this problem/issue. Review the ANA Nursing Code of Ethics and the ICN Code of Ethics and select one you find most applicable to the healthcare topic/issue and policy and/or policy solution.

Criteria and Suggestions for Selecting Issues

Selected topics must meet all of the following criteria:

5. Be practice-focused and highly relevant to positive health care outcomes and global wellness
6. Have cultural implications for inclusive care
7. Have implications for health policy that could have a global impact
8. Topic must be amenable to legislation, government regulation and global recommendations for a solution or improvement. Think about how to effect change that is relevant, significant and sustainable.
9. Have evidence-based information as well as other evidence to support the area
10. Relate to at least one of the following aspects of care: access, quality, cost relating to support for positive healthcare outcomes.

The following lists of topics are intended as suggestions of broad topics you might consider, and then you can narrow your topic:

• Health Determinants
• Cultural Diversity and Inclusion
• Disease Control
• Ethical and Human Rights
• Environmental Health Concerns
• Genomics
• Technology
• Nutrition and Wellness
• Woman’s Health
• Children’s Health
• Healthcare Disaster Preparedness