The stressors inflicted on the U.S. health care system during the COVID-19 pandemic revealed the impact of health care disparities on children and youth living with diabetes, according to ADA President, Health Care & Education, Cynthia E. Muñoz, PhD, MPH.
In her Scientific Sessions address on Saturday, June 26, Dr. Muñoz discussed the impact of systemic health care disparities on children with diabetes and what the ADA is doing to address those disparities. The address, The Changing Face of Pediatric Diabetes—How the Pandemic Brought an Epidemic to Light, can be viewed by registered meeting attendees at ADA2021.org through September 29, 2021. If you haven’t registered for the Virtual 81st Scientific Sessions, register today to access all of the valuable meeting content.
“Unfortunately, these inequities are independent of the pandemic—many of us just never noticed them until now,” said Dr. Muñoz, Assistant Professor of Clinical Pediatrics, University of Southern California Keck School of Medicine, and a pediatric psychologist at Children’s Hospital Los Angeles (CHLA). “If you are outraged about the impact on adults, you should be even more outraged that this is happening to our children.”
Dr. Muñoz said that approximately 85% of the children treated by CHLA are Black, Indigenous, and People of Color (BIPOC); 60% have limited English proficiency; and 70% are publicly insured. Looking specifically at type 2 pediatric diabetes patients, 94% are publicly insured and more than 80% identify as Latinx, she said.
“In our community, like so many others, diabetes disproportionately affects people of color and low-income households, which can often, unfortunately, be one and the same,” Dr. Muñoz said. “The demographics of diabetes in children and adolescents have changed. Type 1 diabetes has been on the rise, but type 2 is still a relatively new entity in pediatrics.”
Despite advances in diabetes therapy and technology, the trend of higher A1C in children and youth is ongoing while misdiagnosis and diabetic ketoacidosis continue to be issues, she said.
“The COVID-19 pandemic further exacerbated these trends,” Dr. Muñoz added. “Timely diagnosis and symptom management became more difficult during the pandemic because children stopped going to well visits and there was hesitancy to go to the emergency department. And with schools closed, families also lacked access to school-based health support.”
Meanwhile, shelter-in-place orders and physical distancing guidelines contributed to a decrease in opportunities for physical activity, and, with reduced employment opportunities, families experienced more difficulty buying diabetes supplies and food, she said.
“During the pandemic, education, health care, support, and most all aspects of life became only accessible on the computer,” Dr. Muñoz said. “The pandemic created a digital divide, as many in under-resourced areas had less access to the very technology—telehealth, education, insulin pumps, and continuous glucose monitors—needed to optimally manage their health.”
The pandemic also illuminated inequities and barriers to mental health care and support for children living with diabetes, particularly those in low-income communities, said Dr. Muñoz, noting that children and youth generally reported lower health-related quality of life during the pandemic and more mental health problems, including higher levels of anxiety.
“To meet the mental health needs of our growing diabetes population, we need to train more mental health professionals who work in outpatient, inpatient, and residential behavioral health treatment centers about the care of people with diabetes,” Dr. Muñoz said.
To that end, the ADA has partnered with the American Psychological Association to create the Mental Health Provider Diabetes Education Program, a training program designed to increase the capacity of mental health professionals equipped to optimally treat diabetes patients. The ADA also created a first-of-its-kind searchable online Mental Health Provider Directory, which currently lists more than 200 mental health providers.
Ongoing ADA programs continue to address other important issues that disproportionately impact people of color and low-income communities, such as insulin affordability, Medicaid expansion, technology access, and expansion of telehealth services for diabetes self-management education and support, she added.
This session also included remarks from ADA CEO Tracey D. Brown, MBA, BChE, and presentation of the Outstanding Educator in Diabetes Award Lecture by Denise Charron-Prochownik, PhD, CPNP, RN, FAAN.