Purpose of Review

Even with insurance coverage increasing over time among the population with diabetes, a large proportion continues to have poorly controlled disease. The purpose of this narrative literature review is to describe the social determinants of poor management of type 2 diabetes among the insured population and illustrate drivers of poor outcomes beyond insurance coverage.

Recent Findings

Despite the provision of health insurance, social determinants play a significant role in shaping diabetes outcomes, especially for economic instability (employment, out-of-pocket expenses associated with diabetes management), food insecurity, education and literacy, access to quality health care (health systems designed to effectively manage chronic disease), neighborhood and the built environment (segregated neighborhoods, socioeconomic conditions of communities, housing), and social and community context (discrimination, social support).

Summary

Multiple social determinants shape poor diabetes outcomes among the insured. These determinants are now being further exacerbated by the COVID-19 pandemic, which has created the worst economic crisis for US families since the Great Depression. The evidence of this review points to the imperative need for more multilevel intervention approaches to address these determinants in the management of diabetes.

中文翻译：

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受保人 2 型糖尿病管理不善的社会决定因素

审查目的

即使糖尿病患者的保险范围随着时间的推移而增加，但仍有很大一部分人的疾病控制不佳。这篇叙述性文献综述的目的是描述投保人群中 2 型糖尿病管理不善的社会决定因素，并说明超出保险范围的不良结果的驱动因素。

最近的发现

尽管提供了健康保险，但社会决定因素在影响糖尿病结局方面发挥着重要作用，特别是在经济不稳定（就业、与糖尿病管理相关的自付费用）、粮食不安全、教育和识字、获得优质医疗保健方面。旨在有效管理慢性病的卫生系统）、社区和建筑环境（隔离的社区、社区的社会经济条件、住房）以及社会和社区环境（歧视、社会支持）。

概括

多种社会决定因素在被保险人中塑造了不良的糖尿病结局。COVID-19 大流行现在进一步加剧了这些决定因素，这给美国家庭造成了自大萧条以来最严重的经济危机。本综述的证据表明，迫切需要更多的多层次干预方法来解决糖尿病管理中的这些决定因素。