2 in 5 Native Americans visit ER due to diabetes complications, survey finds

Some 42% of Native Americans have visited the ER because of a Type 2 diabetes complication, a new survey showed.

The survey (PDF) reached 402 Native Americans living with Type 2 diabetes and was conducted by Podimetrics and independent market research firm PureSpectrum. The survey tried to understand how Native Americans are disproportionately impacted by the challenges associated with Type 2 diabetes.

Native Americans have the highest diabetes rates among all racial groups in America, at 14.5%. 

“We always wanted to go after the most vulnerable patient populations,” Podimetrics CEO and co-founder Jon Bloom, M.D., told Fierce Healthcare. “We first need to raise our level of understanding about how devastated these communities are by diabetes.” 

Podimetrics is the maker of SmartMat, a device that aims to prevent foot amputations in diabetic patients. It has previously received FDA clearance.

Comorbidities and other disparities  

The vast majority of respondents (85%) said they are aware that amputations are associated with unmanaged diabetes. At the same time, more than a third are worried they may need an amputation in their lifetime—and 17% said they have already experienced a lower extremity amputation.

More than a third (42%) reported visiting the emergency department because of Type 2 diabetes complications, with nearly two-thirds of that group saying they have been three or more times. Men were more likely to be worried about experiencing an amputation in their lifetime than women, at 52% compared to 36%, respectively. 

Three-quarters of respondents report living with one or more physical comorbidities that complicate their Type 2 diabetes. The most commonly mentioned comorbidities include obesity (62%), arthritis (49%), asthma (41%) and heart disease (24%).

More than half reported living with a chronic behavioral health condition in addition to diabetes. Of those suffering from such a condition, 76% report experiencing depression and 65% report high levels of anxiety. 

Lack of access to specialist care 

The findings reinforced the fact that Native Americans’ health disparities impact their view of the health system.

Nearly half of respondents believe it is harder for them to access high-quality care compared to other races and ethnicities. Less than a third feel the system was designed to improve their health. More than half believe societal factors beyond their control are directly contributing to their poor health. 

When asked to rate the quality of their healthcare, more than half of respondents rated it as “ok,” “poor” or “horrible.” 

When asked what attributes their providers possessed that best contributed to their healthcare, respondents said compassion (47%), providers’ access to top tech resources (30%) and providers connecting them to the best education resources to prevent complications (30%).

Access to care is a major issue affecting Native Americans, according to one podiatric physician. Janet Simon, D.P.M., is executive director of the New Mexico Podiatric Medical Association and practices in the state of New Mexico. Nearly all of her patients on one reservation are diabetic, and many have comorbidities.

“Finding any type of specialist is very difficult,” Simon,who was quoted in the Podimetrics survey report, told Fierce Healthcare.

Specialists are key to intervening and treating conditions like diabetes early on before they progress. Even if a specialist exists in an area, wait times can be long—when patients need to be seen urgently. The local ER becomes the fallback, Simon said, which often does not get at the root cause of a presenting problem. A better workaround is to try to get a specialist on the phone.

The social determinants of health at play 

A total of 40% of respondents reported receiving support from various groups to address social determinants of health, with nutrition assistance being the most common (61%). Many received free durable medical equipment and at-home diagnostics or health assessments, as well as transportation assistance. 

More than a third have virtual healthcare visits, and a quarter receive housing assistance.

Respondents were most likely to receive such help from their providers, followed by their health plans and support from another government agency besides the Centers for Medicare & Medicaid Services.

Hope in remote patient monitoring 

Though remote patient monitoring (RPM) has the potential to improve interventions and outcomes for patients, many Native Americans have never used RPM, the survey revealed. Less than half reported ever having used RPM that connected them to their doctors, though 81% believe that it should automatically be included as part of routine Type 2 diabetes care.

RPM was the most commonly cited strategy that respondents believed would improve their health (48%), beating out more affordable medications (47%) and expanded access to telehealth (36%). 

Women were less likely to report using an RPM device connected to their doctors than men, at 37% compared to 51%, respectively.

Among those who reported using RPM devices, most included a smart glucose monitor (63%), a smartwatch (61%) or a smart scale (37%). A quarter reported using a smart mat, like the kind Podimetrics makes. Nearly half of patients who had access to an RPM device got one through their provider.

Of those who have used RPM, a third said it came with no clinical support services that helped them between doctors' visits. When asked what benefits combining RPM with clinical services would unlock, 65% said it would help with medication adherence and 54% said it would keep them informed about their health risks.

Simon said she knows that technology can help but has never used RPM as a provider. “Medicine is unfortunately a much slower adopter of a lot of things. It takes a while,” she said.

The patients she sees on the reservation lack access to RPM. While the private practice in Albuquerque, New Mexico, that Simon works at has considered using RPM, the office is dealing with more immediate pressures such as workforce shortages.

“We see the benefit. It’s how can we do a better job of getting it integrated so that it actually is working for everyone?” Simon said.

Given how much respondents support RPM, Podimetrics advocates for integrating digital health tools into routine diabetes care, according to a report on the survey findings. It also emphasizes the need to develop SDOH resources specific to the Native American population, to advocate for health equity, to intervene early to prevent worse outcomes and to follow American Diabetes Association (ADA) guidelines on eye, kidney and foot health.

In 2022, Podimetrics teamed up with the ADA to launch the Amputation Prevention Alliance, an initiative that aims to tackle diabetes-related disparities like amputations and deaths among minority communities.