New Minnesota research links low income, diabetes

Low-income adults in Minnesota are much more likely to develop diabetes than people with higher incomes, according to the Minnesota Department of Health.

New research shows that 13 percent of working-age Minnesotans who earn less than $35,000 annually have diabetes. That compares to a diabetes rate of just 5 percent for earners who make more than $35,000.

Income was consistently associated with disease rates even when other risk factors, such as age and education levels, were factored out.

The report does not address which comes first, lower income or diabetes. But the agency found that people who have the condition are much less likely to be able to maintain a job than those who do not have the disease. One in three adults with diabetes is jobless, compared to one in ten who do not have diabetes, according to the report. That could suggest they may have had to leave the workforce because of their condition.

Previous research suggests that having low income in childhood or mid-life can contribute to developing the disease.

Ed Ehlinger, health commissioner, says diabetes is not easy to manage, even in the best of circumstances.

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"If you have good income, if you have stable housing, if you've got relationships that are supportive, it's hard enough," he said. "If you add things like low income and insecure housing and lack of access to food and poor transportation, it's just going to make it increasingly difficult."

The report's findings come as no surprise to Ross Owen, director of Hennepin Health, a managed care program serving primarily single adults who are on Medicaid or MinnesotaCare.

More than 22 percent of Hennepin Health's patients have diabetes. Many also have chemical addictions, mental health issues and unstable housing arrangements.

Owen says a traditional health care approach to diabetes, one that emphasizes behavior change, wouldn't work well with his patient population. He says basic needs have to be met first. So providers find out if their clients need housing or food and connect them with services.

"One of the first things that we learned is that we have to ask," he said. "If we don't establish a relationship and ask people about what's going on in their life outside of the walls of our clinic and our hospital, we don't know."

The approach has helped Hennepin Health keep its patients on track in meeting statewide diabetes care measures.

But such efforts alone won't prevent diabetes and bring down disease rates among low income, racially diverse patients, says Moriah Johnson, who runs the health promotion program at Native American Community Clinic in Minneapolis. She says lifestyle changes are difficult.

"You kind of get the feeling sometimes that you're hitting your head up against the wall," she said. "You're doing the same things over and over again. We haven't seen huge, huge improvements."

The report says the state could do more to prevent diabetes, including dropping co-pays for low-income people, improving access to healthy, affordable foods and creating more opportunities for physical activity.