Accessibility and utilization of healthcare services among diabetic patients: Is diabetes a poor man’s ailment?

Table 1 Empirical evidence concerning association between diabetes and poverty

Publication year	Objective(s)	Design	Data collection	Results	Ref.
2013	The study examined the association between neighborhood-level poverty and hospital admission rates for T2DM in Rhode Island	Longitudinal study	Rhode Island’s hospital discharge data	The study found that poverty increased from 3% to 40%, and the associated diabetes admission rates increased from less than 2% to 30% per 1000 residents	[9]
2011	The study examined ‘‘upstream’’ influences (the social determinants of health) that contribute to ‘‘downstream’’ health disparities, focusing on variations in T2DM risk	Exploratory study	Mixed data collection of focus group and survey	The results showed that the most significant barriers to health and the source of T2DM disparities in the target population were structural. In other words, they were derived from the conditions within which individuals live, work, and play	[17]
2002	The study investigated the profile of diabetes and its complications	Comparative study	Medical diagnosis	The results revealed that the prevalence of diabetes and impaired glucose tolerance was substantially lower among the low-income group than in the high-income group	[19]
2012	The study assessed the relationship between SES and T2DM in India	Cross-sectional survey	Self-reporting diabetes status	The study revealed that individuals with the highest SES seem to be at extreme risk for T2DM	[20]
2012	The study sought to determine whether inequality of income was connected with diabetes prevalence and inequality of care under a national health insurance program in Asia	Cross-sectional survey	National Health Insurance Scheme	The study revealed that the prevalence of diabetes was higher in low-income earners compared to middle-income counterparts	[21]
2014	The study examined the role of neighborhood poverty and racial composition in predicting race differences in diabetes incidence	Cross-sectional survey	The National Health and Nutrition Examination Survey, medical examination and interview	The study found that poverty was positively associated with diabetes for both Black and White people. Residing in a poor neighborhood amplified the odds of having diabetes for Black and White people	[22]
2019	It evaluated socioeconomic disparities in undiagnosed, diagnosed, and total diabetes as well as lifestyle variables as contributing factors to diabetes disparities in South Africa	Cross-sectional study	South African National Health and Nutrition Examination Survey	As measured by self-reported clinical data, diabetes was more prevalent among higher socioeconomic groups in South Africa	[23]
2023	This study compared rural-urban differentials in prevalence and lifestyle factors associated with pre-diabetes and diabetes in the elderly in southwest China	Cross-sectional health interview and examination survey	Anthropometric measurements as well as blood pressure and fasting blood glucose measurements	The study revealed that the incidence of pre-diabetes and diabetes was higher among urban older adults compared to their rural contemporaries in southwest China	[24]
2023	The study examined the trends in income-related inequalities in diabetes prevalence and identified the contribution of determining factors	Estimation of income-related inequalities in diagnosed diabetes	National Health Interview Survey	The study revealed that diabetes was more prevalent in low-income populations

SES: Socioeconomic status; T2DM: Type 2 diabetes mellitus.

Table 2 Accessibility of healthcare services among diabetic patients

Publication year	Objective(s)	Design	Data collection	Results	Ref.
2018	The study examined diabetic patients’ access to hemoglobin A1c testing in rural Africa	Review	-	The study proposed that routine access to hemoglobin A1c testing would allow for close monitoring of diabetes control as well as provide critical data informing the population level of diabetes complications. The study equally revealed that the major limitation for rural patients’ access to health care included high-cost medical services and a lack of preservative facilities	[10]
2005	The study assessed the barriers to care for patients with insulin-requiring diabetes	Rapid assessment protocol	Interviews, discussions, and site visits	The study revealed that several factors limited patients’ access to diabetes care, which included inadequate supply, the problem of quantification of need, equitable distribution of insulin, and unavailability of syringes and testing equipment	[11]
2019	This study analyzed the diabetes-related information routine in Kwazulu Natal	Descriptive survey	Data from the District Health information system of South Africa	The study revealed that the number of diabetic patients seeking medical care increased 305% between 2006 to 2015, while the number of defaulters has decreased since 2012	[26]
2015	The study investigated females’ experience with diabetes care in Soweto, a township of Johannesburg	Qualitative study	Interview	The study revealed that females identified structural barriers such as overcrowded clinics and poor access to medicines as hindering treatment adherence	[27]
2012	This study examined the association between access to health care and diabetes control	Correlational research	National Health and Nutrition Examination Survey, current health insurance coverage	The study revealed that lack of access to health care was linked with severe diabetic ailments. Diabetes control was associated with insurance coverage and some healthcare visits	[28]
2022	The study examined diabetes care factors and assessed their relative importance	Cross-sectional study	Survey questionnaire	The study revealed that accessibility of diabetes care, availability of diabetes services, quality of diabetes care, diabetes management strategies, a health system’s basic amenities, and health education resources played a significant role in providing diabetes care services	[29]
2019	The study aimed to comprehend the factors that affected the utilization of DRSS and follow-up to inform health promotion strategies and improve the uptake of these services	Qualitative study	Focus group discussion	The study found that several factors affected patient uptake of diabetic retinopathy screening services, which included a lack of knowledge of both conditions and the need for screening, economic reasons, institutional factors, long waiting times at eye clinics, and fear of discomfort among others	[30]

DRSS: Diabetic Retinopathy Severity Scale.

Table 3 Utilization of healthcare services among diabetic patients

Publication year	Objective(s)	Design	Data collection	Results	Ref.
2020	The purpose of this study was to investigate the service needs and healthcare utilization among people with T2DM	Cross-sectional study	Self-report questionnaire	The study revealed that diabetic patients utilized outpatient visits, special visits, general practitioner visits, emergency room, and hospitalization	[14]
2021	The study investigated the impact of diabetes comorbidities on the health care use and cost of a cohort of elderly patients with diabetes and high care needs based on real-world data	Descriptive survey	National Health Datasets	The results showed that high-need elderly patients accessed emergency care and several outpatient visits	[32]
2005	This study described differences in healthcare utilization and indicators of patients with diabetes based on gender	Survey	Computerized medical record	The study revealed that females with diabetes use more healthcare services and have a higher morbidity rate than their male counterparts	[33]
2022	This study compared the utilization of primary healthcare services by elderly patients with and without T2DM	Survey study	Electronic patient records, health-related quality of life, self-rated health	Patients with diabetes utilized primary healthcare more than those without diabetes	[34]
2022	This study evaluated whether social determinants were associated with an increased risk of proliferative diabetic retinopathy	Survey study	National Institutes of Health All of Us Research Program data repository	This study revealed that patients affirmed that financial concerns and lack of access to transportation were the major reasons for delaying or avoiding access to health care	[35]
2022	The study examined the costs sustained by patients with IDDM who received hospital inpatient/observation/emergency department care (Higher care) for diabetes-related events with those who did not receive such care to identify a target group for treatment in a subsequent study	Institutional review	Documented institutional data	It was found in the study that 8.4% of IDDM patients received higher care yet incurred 20% in medical costs and nearly 40% in diabetic-related spending	[36]
2017	A study was conducted in Bangladesh to determine diabetes-related knowledge and factors affecting healthcare services utilization among patients with T2DM	Analytical study	Interviewer and semi-structured questionnaires	Among patients with T2DM, the study found that patients had average knowledge of diabetes management, which might affect the use of healthcare services	[37]

IDDM: Insulin-dependent diabetes mellitus; T2DM: Type 2 diabetes mellitus.