In 2020, 8.8% of Minnesota adults (about 390,000) have been diagnosed with diabetes (type 1 or 2). However, this number masks the existing disparity across people with different incomes. More than 80% of adults aged 18-64 are living in poverty in Minnesota, and are two-and-half times as likely to have diabetes as those with incomes higher than $35,000. And the low-income population in Minnesota mostly comprises of people of color.

Diabetes is a chronic condition that affects how the body breaks down sugar. The body doesn’t make enough insulin or can’t use it as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in the bloodstream. People with diabetes are at high risk of heart disease, stroke, and other serious complications, such as kidney failure, blindness, and amputation of a toe, foot, or leg. Insulin is the original and the most effective treatment to control glucose levels in diabetic patients.

Scientific literature suggests that having low income or socioeconomic status in childhood or mid-life can contribute to developing diabetes. On the other hand, working-age adults with diabetes are more likely to exit the workforce, retire early, and to have less earnings than their counterparts without diabetes. The costs of diabetes includes treatment and medication costs which could potentially burn a hole in ones pocket if they are not covered under insurance.

Diabetes is preventable. Participating in lifestyle change programs like the National Diabetes Prevention Program (National DPP) can help people lose weight, eat healthy, increase physical activity and reduce their risk of developing diabetes. Twenty-nine thousand and five hundred Minnesotans are enrolled in the National DPP program and the Minnesota Department of Health is making efforts to reduce the prevalence of diabetes in the state. The primary prevention goal of the Minnesota Medicaid Incentives for Prevention of Diabetes targeted weight loss as the gateway to long-term reductions in diabetes, improved cardiovascular health, and reduced health care expenditures.

The Minnesota Legislature is aware that low-income adults face greater difficulties due to the high costs of medical treatment for diabetes and are taking conscious steps to address the problem. In 2020, the Legislature passed the Alec Smith Insulin Affordability Act. The act created an insulin safety net program that aids individuals who cannot afford insulin.

How can Minnesota do better?

Although the state of Minnesota recognizes the problem, it still has not implemented a Diabetes Action Plan. With a prevalence of 385,600 diabetes cases, the state spends $3.5 billion per year in direct medical costs attributed to diabetes.

As the rising rates of diabetes is closely linked to the economic status of people, the state should focus on improving living conditions, providing more job opportunities, and increasing access to affordable healthy food. Another potential solution is eliminating co-pays and other cost related barriers to participation in diabetes prevention and management programs.

Expansion of Medicaid program to support more low-income people and subsidizing the cost of insulin and continuous glucose monitors under insurance can potentially help diabetics and pre-diabetics. This would increase the upfront costs for the state and might face some pushback, but in the long run this would drastically reduce the state spending on diabetes care.

In order to achieve the goal of health equity, a plan of change targeting low-income communities should be the top priority of the state right now.

Vedushi M. Jain is a graduate student in Health Administration and Policy at the University of Minnesota School of Public Health.