Blood Sugar Rising?

In Alberta, Canada, 12% of the population has Type 1 or Type 2 diabetes. The cost of diabetes in the health care system is $494 million, and it costs each person $500-$2400/year, depending on medication type (Diabetes Canada, 2022). In home care, we see the adverse effects of diabetes and how it is costly, physically, mentally, and financially on the client and their loved ones. There are no one-fit-all solutions in providing primary, secondary, and tertiary care for clients with diabetes. Each client is unique and needs to be addressed as such. Using a socio-ecological model, we will review what impacts clients with diabetes and how we can start addressing these factors.

Socio-Ecological Model

The Socio-ecological model focuses on the individual and their environment, past and present. As seen in the image above, the model consists of five levels, starting from the individual and expanding outward. The individual level focuses on the client's physical characteristics (age, sex, race, and genetics), income, and education. Secondly, the interpersonal level centers on the individual's relationships and social networks. Organizations and groups that directly impact the individual, an example would be a person's workplace, constitute the third organizational level. The fourth level, community, focuses on the relationships between organizations. Finally, the public policy level focuses on provincial and national laws and regulations (Poux, 2017 & Lee et al., 2017).

Let's do an in-depth review of the socio-ecological model focusing on a person with diabetes.

Individual

As outlined in the image above, diabetes affects about 7% of Canadians, with devastating effects such as heart disease, lower limb amputation, and time lost from work. Males are more at risk than females (Public Health Agency of Canada & Pan-Canadian Public Health Network, 2019), and non-Caucasian races are at a significantly higher risk. Indigenous adults in Canada are at 1.9 times higher risk, South Asian adults are at 2.3 times higher risk, and Black adults are at 2.1 times higher risk. (Hill-Briggs, 2022 & Public Health Agency of Canada & Pan-Canadian Public Health Network, 2019) Several studies have shown that the more education an individual has, the risk of diabetes decreases. This may be due to multiple factors, such as increased employment opportunities and the ability to afford health insurance. (Gary-Webb et al., 2013, & Ejslvok, 2018). Seniors are also at an increased risk, possibly due to lower income and social isolation (Brown et al., 2018)

Interpersonal

Close relationships and social networks play an essential part in an individual's risk factors for diabetes by influencing health behavior (Gary-Webb et al., 2013). Having close relationships with others who are obese increases the risk of the individual becoming obese. If positive relationships encourage diabetes management or prevention, risk factors decrease. Alternately, if close relationships have negative views or practices, the individual will often reflect these views (Gary-Webb et al., 2013). Incorporating an individual's cultural traditions, views, and knowledge significantly increases the uptake of diabetes education, prevention strategies, and treatments (Walls et al., 2022).

Organizational

Organizations and groups that have a direct impact and influence on the individual constitutes the third level of the socio-ecological model. Examples include workplaces, schools and social networks. Lawrence et al., 2018, reviewed the support available in Ontario schools for students with Type 1 diabetes. Only 48% of students had a care plan to manage their diabetes at school, and 21% had to decrease insulin doses to prevent hypoglycemia independently. If schools had more staff trained in diabetes, this could lead to improved control for the individuals. Watson et al. did a study in 2019-2021 by implementing diabetes education in two public workplaces. Below you can see a summary of the results.

In Canada, Tarride et al., 2018, reviewed the effectiveness of diabetes screening in workplace environments. This study showed that increased work support is directly linked to improved A1C scores for staff with Type 2 diabetes.

Community

The next level that impacts health is how organizations interact with each other and an individual's neighborhood. Poverty level, distance from recreation areas, access to public transportation, and crime rates are all examples of neighborhood risk factors (Gary-Webb et al., 2013). Lim et al., 2020, have also linked housing instability with higher rates of diabetes.

The Government of Alberta and Alberta Health Services have created MyHealth.Alberta.ca to provide up-to-date resources on many health concerns, including diabetes.

Diabetes Canada is another excellent group that works with many organizations to promote diabetes education, research, and funding.

Public Policy

Any provincial and national laws, regulations, and acts can significantly impact individuals with diabetes (Poux, 2017). Alberta does have a Social Policy Framework that outlines and guides what Albertans want to see in our public policy. The Alberta Government also has a Strategic Approach to Wellness that was created in 2014. This document was created to supplement the Strategic Approach to Wellness framework. It outlines five strategies to improve Albertan's wellness. These include "improving health knowledge…, building communities that create wellness, improving social and economic supports for wellness, strengthening primary prevention with primary health care, building healthy public policy." Bowman et al., 2012, clearly shows that having a framework for policymakers dramatically improves the quality of public policy relating to health and wellness.

In summary, the socio-ecological model helps healthcare professionals look at the individual as a person and within their environment. Being aware of the organizations and communities that directly impact an individual also provides healthcare professionals insight into how to address current health concerns. Finally, being aware of public policy allows professionals to influence change at a high level and review how it affects individuals. In the case of diabetes management in Alberta, healthcare professionals must be aware of all five levels of the socio-ecological model to provide holistic care to our patients and decrease the cost on the healthcare system