Association Between Rental Assistance Programs and Undiagnosed Diabetes Among U.S.

BACKGROUND: Rental assistance programs have been linked to better housing quality, stability, healthcare access, and reduced likelihood of uncontrolled diabetes. However, its direct association with diabetes screening is uncertain. OBJECTIVE: To determine whether federal rental assistance programs are associated with lower odds of undiagnosed diabetes. DESIGN: We used a quasi-experimental approach, comparing outcomes among adults receiving rental assistance to those who entered assisted housing within 2 years after their health data were collected. We test the a priori hypothesis that rental assistance will be associated with decreased odds of undiagnosed diabetes. PARTICIPANTS: Participants in the National Health and Nutrition Examination Survey 1999-2018 who received rental assistance and who had diabetes. INTERVENTION: Current rental assistance participation, including specific housing programs. MAIN MEASURES: Undiagnosed diabetes based on having hemoglobin A1c ≥ 6.5% but answering no to the survey question of being diagnosed with diabetes. KEY RESULTS: Among 435 eligible adults (median age 54.5 years, female 68.5%, non-Hispanic white 32.5%), 80.7% were receiving rental assistance programs at the time of the interview, and 19.3% went on to receive rental assistance within 2 years. The rates of undiagnosed diabetes were 15.0% and 25.3% among those receiving rental assistance programs vs. those in the future assistance group (p-value = 0.07). In an adjusted logistic regression model, adults receiving rental assistance had lower odds of undiagnosed diabetes (OR 0.52, 95% CI 0.28-0.94) than those in future assistance groups. Sex, race and ethnic group, educational level, and poverty ratio were not significantly associated with having undiagnosed diabetes, but individuals aged 45-64 years had significantly lower odds of undiagnosed diabetes (OR 0.21, 95% CI 0.08-0.53) compared with those aged 18-44. CONCLUSIONS: Rental assistance was linked to lower odds of undiagnosed diabetes, suggesting that affordable housing programs can aid in early recognition and diagnosis, which may improve long-term outcomes.

Feasibility and Acceptability of an Agenda-Setting Kit in the Care of People With Type 2 Diabetes: The QBSAFE ASK Feasibility Study.

This article reports on a study to assess the feasibility of research procedures and acceptability of QBSAFE, a set of conversation cards focused on quality of life, treatment burden, safety, and avoidance of future events in people with type 2 diabetes. The study enrolled 84 patients and 7 clinicians. Of the 58 patients who completed questionnaires, 64% agreed that the QBSAFE agenda-setting kit (ASK) helped them discuss their situation, 78% agreed that others could benefit from it, and 38% said they would use it again. Most clinicians felt confident responding to issues (in 89% of encounters) and said they would use the kit again (78%) and recommend it to colleagues (82%). The QBSAFE ASK can be feasibly implemented and holds promise in facilitating discussion and collaborative problem-solving.

Role of metformin in the management of type 2 diabetes: recent advances.

Metformin is one of the oldest antidiabetic medications, commonly used in the management of type 2 diabetes. Its mechanism of action is based on reducing glucose production in the liver, decreasing insulin resistance, and increasing insulin sensitivity. The drug has been studied extensively and has been shown to be effective in lowering blood glucose levels without increasing the risk of hypoglycemia. It has been used for the treatment of obesity, gestational diabetes, and polycystic ovary syndrome. According to current guidelines, metformin can be used as the first­line agent in the management of diabetes; however, in individuals with type 2 diabetes who would benefit from cardio­renal protection, newer agents, such as sodium­glucose cotransporter­2 inhibitors and glucagon­like peptide­1 receptor agonists, are favored as the first­line therapy. The novel classes of antidiabetic medications have demonstrated significant positive effects on glycemia with added benefits in patients with obesity, renal disease, heart failure, and cardiovascular disease. The emergence of these more effective agents has significantly altered the way diabetes is managed, thus prompting re­evaluation of metformin as the initial therapy for all patients with diabetes.