There is a costly, debilitating, and sometimes deadly pandemic raging across the globe. And, no, we are not talking about COVID-19. In fact, it is one that is much more entrenched and widespread … diabetes.
In the U.S. alone, 37.3 million (11.3%) adults were living with diabetes in 2019. To put that into perspective, at its highest point, only 1.3 million Americans had COVID at the same time.
Almost half (44%) of people with diabetes worldwide don’t even know they have the disease.
Diabetes can cause heart disease, chronic kidney disease, neuropathy or nerve damage, and other complications.
This year the International Diabetes Federation and the World Health Organization have set as their theme, “Access to Diabetes Care,” emphasizing the importance of access to quality diabetes care and education for healthcare professionals and people with the disease.
“Accessing care means not only does there have to be a source of diabetes care available, but people must have the time, money, transportation, childcare, etc., to reach it and no other pressing concerns that take priority. Even once someone is seen by a doctor, the same barriers to care remain," explains Melissa Elafros, M.D., Ph.D., Assistant Professor of Neurology at Michigan Medicine and faculty at the NeuroNetwork for Emerging Therapies.
“Can we truly say that we have improved access to diabetes care if someone knows he has diabetes but cannot afford his medication, see a specialist, or safely do the things his doctor recommends?”
Dr. Elafros is leading “The Flint Neuropathy Study,” in partnership with internal medicine providers at Hurley Medical Center and funded by the National Institutes of Health (NIH), which seeks to understand the extent of undiagnosed neuropathy and diabetes among primary care patients in Flint.
“The population we treat is an underserved community,” explained Thair Dawood, M.D., Internal Medicine core faculty member at Hurley Medical Center, and Assistant Professor at Michigan State University’s College of Human Medicine, who is a collaborator with the study. “Generally, they are of low socioeconomic status, uninsured, and often unaware of their health status and issues.”
“There are times we send our patients home with instructions that they cannot read, unbeknownst to us. So, making sure they receive the care they need can be very challenging.”
Fifty percent of the adults participating in the Flint Neuropathy Study had previously been diagnosed with diabetes or prediabetes; however, an additional 27% were diagnosed with these conditions during the study. Further, 67% of patients were found to have neuropathy, and most were unaware of it.
“While health care providers and diabetes organizations, like the International Diabetes Federation, know that many people with diabetes and neuropathy do not know they have these conditions, we were stunned by how many new diagnoses we made,” said Dr. Elafros.
As Lexi Gagne, MPH, Study Coordinator for the Flint Neuropathy Study, explains, this is particularly problematic: “Neuropathy occurs when there is damage to the nerves in the arms and legs, which makes it hard for people to feel if they step on something sharp. So, if they get a cut on their foot, it is often more likely to get infected and lead to an amputation than people who not have neuropathy.”
Diagnosing diabetes and its complications like neuropathy is essential so that patients are provided with the education they need to care for their medical conditions. Not only are Dr. Elafros and her colleagues helping link study participants with diabetes and neuropathy to the resources they need, but they are also working to understand why these conditions are underdiagnosed in Flint patients.
Michele Heisler, M.D., MPH, Professor of Internal Medicine and Public Health and Co-Director of Michigan Center for Diabetes Translational Research, explains the significance of the team’s research: “The Flint Neuropathy Study represents a pioneering initiative to bring together primary care doctors, who often see diabetes in the very early stages of disease, and neurologists, who too often only get involved when diabetes complications like neuropathy have already become very severe.”
“By characterizing where there are gaps in diabetes care in Flint and addressing them, Dr. Elafros and her team are working to improve access to knowledge and interventions earlier to improve patient outcomes and quality of life. We need more collaborations like this one across medical specialties.”