Environmental Factors and Diabetes

environmental factors and diabetes

Diabetes is one of the most common chronic conditions in America. In 2021, 38.4 million Americans had diabetes. The health effects of diabetes are significant, including the risk of heart disease, nerve damage, kidney damage, and vision loss. In 2022, cumulative costs for health care related to diabetes were over $412 billion.

This 2022 infographic compares the number of diabetic and prediabetic Americans. Source: Centers for Disease Control and Prevention


Managing diabetes risks is a public health priority. Diabetes risk can’t be calculated purely on the basis of biological markers. The health determinants of diabetes extend into the realm of social determinants of health. 

Social determinants of health refer to non-medical factors that can influence health status. The Center for Medicare and Medicaid Services lists five specific categories as social determinants of health: 

  • Living environment
  • Access to food
  • Employment status
  • Education and literacy levels
  • Family circumstances

There is a widely accepted body of research that demonstrates that all of these factors can have a direct impact on an individual’s risk of developing diabetes. Understanding the interplay between environmental factors and diabetes can help care providers better understand diabetes risk, and take steps to mitigate unnecessary complications.

Living Environment

The natural and built environment in which a person lives may not seem to be a significant influence over diabetes risk. However, the nature of a community can have an outsized impact on food availability, both in terms of quality and type. Food deserts are communities with sparse access to grocery stores, leaving residents without access to fresh food and ingredients. 

In a study published in The Lancet, investigators noted a link between type 2 diabetes and living in so-called “food swamps.” Food swamps are areas where options such as fast food, junk food, and convenience stores outnumber outlets selling fresh food and whole ingredients.  

The built environment can also influence access to health care. Rural areas have a higher prevalence of type 2 diabetes than urban areas, in part because of the scarcity of healthcare providers and facilities. In turn, this can lead to worse health outcomes for individuals with diabetes who may not have access to the proper care needed to manage the condition. This includes resources such as A1C testing, diabetic retinopathy screenings, and routine health exams. 

Access to Food

Access to food depends on living environments, as availability is influenced by how close food stores and restaurants are. However, even easy access to outlets that sell healthy food doesn’t mean individuals can obtain healthy food. 

Income levels often dictate food choices. Low income or variable income can lead to food insecurity, which is any situation where access to adequate food is inconsistent. Affordability and insecurity can lead to food choices that rely on high glycemic index foods, which are associated with an increased type 2 diabetes risk. 

Employment Status

Employment status is one of the main drivers of economic stability. Not only do employment and income have a tremendous influence on access to housing and food, but they can also affect health insurance access. 

Fluctuating employment status can lead to changes in eligibility for employer-provided insurance, Medicaid, or CHIP programs. Inconsistent insurance coverage and periodic inability to pay for care may increase the likelihood of skipping medications or doctor appointments. Individuals may have to change doctors frequently, which can lead to doctor-patient miscommunication or errors due to a lack of relevant information. This can lead to unnecessary complications from chronic conditions like diabetes. 

Family Circumstances 

Family circumstances are one facet of the social factors of diabetes. Overall, strong social connections and social support are correlated with better outcomes for diabetes. Often, family members provide core social support as well as practical assistance with tasks like food preparation, transportation to medical appointments, and motivating individuals to make good health choices. 

However, even individuals without reliable, nearby family support may have non-family relationships that fill those needs. 

Education and Literacy

Studies show that greater levels of educational attainment are correlated with a lower prevalence of type 2 diabetes. Diabetes incidence is highest among adults with less than a high school education. Prevalence decreases in those with a high school education and decreases further among those with more than a high school education. 

Education levels also have an effect on socioeconomic status, with lower educational attainment negatively affecting income levels, thus affecting housing, insurance, and food access. 

Low literacy levels can have a more direct effect on diabetes care. If a patient is unable to understand written instructions for diet, lifestyle, and medication management, they may have poorer health outcomes. 

Overcoming Social and Environmental Obstacles to Diabetes Care

Effective diabetes prevention and management programs need to be sensitive to the social and environmental impacts on health as a whole. One way of addressing diabetes care is to simplify access to the core screenings necessary for successful diabetes management. 

Giving primary care providers, home care providers, community clinic staff, mobile health services, and hospital systems the tools to perform comprehensive diabetes assessments — including retinal imaging to screen for diabetic retinopathy — can improve patient outcomes. 

Tools like the IRIS Solution can bring vision screenings into the primary care setting, reducing the risk of vision loss from diabetic retinopathy

Telehealth is another strategy to broaden access to care for patients in rural and underserved communities. Telehealth visits may be especially beneficial to individuals who might otherwise need to travel significant distances for care or who don’t have access to transportation. 

Telehealth solutions for ophthalmology can increase access to critical diabetes care. Annual screenings for diabetic retinopathy are part of the National Committee for Quality Assurance-recommended HEDIS measures for standard diabetes care. 

The IRIS solution is an advanced cloud-based camera-agnostic platform where primary care providers, home health professionals, or other trained technicians can use handheld or tabletop fundus cameras to capture retinal images. The images are sent to the IRIS Reading Center, where licensed eye care physicians evaluate them for signs of eye disease. 

The IRIS Reading Center reports screening results to providers who can advise patients on necessary next steps or treatment options. Conducting retinal screenings in an easy-to-access setting like a primary care office or through in-home care means patients with diabetes can get needed care without making a separate ophthalmology appointment. 

To learn more about how teleretinal screenings can aid diabetic retinopathy prevention in underserved communities, contact us for a free demo of the IRIS Solution



What are environmental factors relating to diabetes?

Diabetes risk can be impacted by a variety of non-medical factors, including: 

  • Living environment
  • Access to food
  • Employment status
  • Education and literacy levels
  • Family circumstances

How do these environmental factors affect rural and underserved communities?

Individuals in rural communities or underserved communities may have limited access to healthcare services, which can increase diabetes and related complications. In addition, rural and underserved communities may lack accessible and affordable access to healthy food. 

Low income and employment instability — which can be exacerbated by low educational attainment —  can result in delaying or skipping medical care. This might be due to inability to pay, loss of access to a particular doctor due to insurance changes, or the need to relocate for employment reasons.  



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