Being homeless in Canada is accepted as a difficult thing. Being homeless and also being a diabetic is far more challenging, said a new article published this week in the Canadian Medical Association Journal.
The study involved a small group of "co-researchers" who were previously diagnosed with Type 2 Diabetes and experienced homelessness for periods ranging from eight months to 12 years. The study said the subjects endured high levels of stress.
"Coresearchers described homelessness as a highly stressful state that demands that those in its grasp prioritize their most basic needs. The mental energy and time required to figure out where one can safely spend the night, quell one’s hunger and make it through another day leave little room for high-order tasks, like managing diet, medications and exercise."
The study group included three men and five women, representing a diversity of ethnic origins and ages. At the beginning of group meetings, two persons found housing, three were staying in transitional housing, and three were living in shelters or sleeping outdoors.
The study was authored by a group of Canadian physicians and researchers; Rachel B. Campbell, Matthew Larsen, Anna DiGiandomenico, Marleane A. Davidson, Gillian L. Booth, Stephen W. Hwang, Kerry A. McBrien and David J.T. Campbell, associated with University of Calgary Cumming School of Medicine; Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto; and University of Toronto Faculty of Medicine.
The authors said one of the reasons for the study is because not enough attention has been given to the problem. Also, the study was approved by the research ethics boards of the University of Calgary and St. Michael’s Hospital/Unity Health Toronto.
"Minimal consideration has been given to understanding the challenges of managing diabetes while homeless from the perspective of those with lived or living experience. We used a community-based participatory approach to explore these challenges," they wrote.
It was also reported that being homeless made it difficult to prepare healthy foods, to get access to diabetes care professionals and to get prescription medications.
"Homelessness imposed major demands on emotional and mental health, impairing the ability of those affected to focus on diabetes self-management. Foods provided in shelters were often nutritionally poor or unpalatable. Obtaining housing facilitated diabetes management through stability and autonomy, but cost and lack of knowledge posed challenges to healthy food preparation. Homelessness also presented challenges to accessing diabetes care professionals and prescription medications," said the study.
It was also reported that patients with diabetes who experience homelessness often have a difficult time with self-management tasks and face many barriers, given the various health and social challenges they face.
This was outlined in a previous CMAJ report carried out in Toronto more than 20 years ago.
This included financial barriers to accessing daily blood-sugar testing supplies and medications. There are also barriers to accessing proper sugar-free foods, social barriers and prejudice when seeking medical care, threats to their emotional well-being from having no housing, and the challenges of safely storing medications and supplies. Many of these barriers were outlined in a Calgary study from 2015.
The study concluded that the situation is not getting better and hope is expressed that decision-makers will find ways to improve things for people in such vulnerable situations.
"The incidence of homelessness and Type 2 Diabetes among those who face social vulnerabilities has consistently increased, so we expect the issues identified by co-researchers in this study to persist. This study provides a starting place for policy-makers to think about addressing areas of concern for people with lived experience of both diabetes and homelessness. Finally, we hope that this project will show other health researchers that community-based research, including photovoice, with this population is feasible, valuable and essential for understanding this population’s needs and views."
Sudbury area residents can find assistance through the diabetes education and information program, for children and adults, provided by Health Sciences North.