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How lack of insurance pushed East Texas diabetes rates above the national average

A doctor checks a patient's blood sugar level with a glucometer.
A doctor checks a patient's blood sugar level with a glucometer.

Risk factors like obesity, poor diet, and lack of physical activity can contribute to diabetes, but a recent investigation by the nonprofit unit Public Health Watch found another risk factor in East Texas, where diabetes rates in some counties exceed the national average.

KERA’s Sam Baker talked about this with co-writer Kim Krisberg. She covers health care access and the impacts of being uninsured for Public Health Watch, a nonprofit, investigative news organization based in Austin.

The biggest thing we found was that because Texas also has a very high uninsured rate, the ability of patients who have diabetes to get the care they need to manage it so that the disease doesn't progress to more severe outcomes.

That lack of access to care is an impediment to particularly poorer Texans living with diabetes who are trying to manage their disease.

We're talking about people known to have diabetes. What about people who don't know they have it?

Yeah, well, access to care also impacts that population as well, because studies have shown that if you have health insurance, you're more likely to be diagnosed with diabetes, but also more likely to be diagnosed with pre-diabetes, which is really important. The earlier that you can catch it, manage it, and change your behavior, the better your outcomes will likely be.

Your article mentioned a few counties in this predicament.

In Smith County, where Tyler is, 11.8% of adults who are 20 years old and older had been diagnosed with diabetes as of 2020.

Angelina County, where Lufkin is located, 14.5%.

Sabine County, sitting on the border with Louisiana, the rate was 12.4%.

These are all rates that are higher than the national average.

Is the problem more widespread across East Texas than that?

Definitely. I mean, it has a lot of very rural communities, and rural places tend to have historically high uninsured rates, and more poverty, and that all ties together to make it particularly hard for someone living with diabetes.

Short of Texas accessing Medicaid, though, for more people, what can be done about this problem? What are people in these areas doing to help those with diabetes? 

A lot of local health departments in these areas have diabetes education programs, so folks can go and learn more about diet and exercise and know how to manage their disease at home. And studies have shown that diabetes education is really effective at helping people manage the disease.

But what it comes down to is who is able to access diabetes education. Sometimes you can find free classes through your local health department. Sometimes safety net clinics will have diabetes education resources that you can access.

But again, it's typically people who have health insurance who can have the easiest time accessing these resources.

How much of that type of help is available in these areas?

There are, all around Texas, a number of federally qualified safety net clinics that take anybody, regardless of their insurance status. So, there are a number of options where uninsured folks might be able to get help and care for their diabetes.

However, for many of these patients, physicians told us having health insurance would still be better because it would mean that they would likely have been able to access health care much earlier instead of waiting until they actually felt sick to show up at a clinic.

If you have health insurance, you're more likely to go get that preventive care. And, having health insurance would help them access the full range of diabetes medications and prescriptions, including the newest ones on the market that seem to be quite effective.

And when you don't have health insurance, again, you're dependent on what you can get at either very low cost or free through clinics like free insulin and other diabetes medication. But you don't necessarily have access to the full range of diabetes treatments out on the market today.


A slow killer: East Texans are diagnosed with diabetes at a higher rate than the national average

CDC: Texas Diabetes Profile

State Diabetes Plan

Sam Baker is KERA's senior editor and local host for Morning Edition. The native of Beaumont, Texas, also edits and produces radio commentaries and Vital Signs, a series that's part of the station's Breakthroughs initiative. He also was the longtime host of KERA 13’s Emmy Award-winning public affairs program On the Record. He also won an Emmy in 2008 for KERA’s Sharing the Power: A Voter’s Voice Special, and has earned honors from the Associated Press and the Public Radio News Directors Inc.