Have you ever considered whether your surroundings, like availability of healthy food or easy to navigate walking paths, impact your ability to manage your diabetes and maintain an optimal Hba1c? An April 2018 study is the first to examine the direct impact of environment on diabetes management.
Maintaining blood sugar is affected by your ability to lose excess weight or maintain a healthy weight, and that in turn is affected by access to exercise opportunities and access to healthy food. If you can’t go outside for regular exercise because it’s not safe or because you live in an urban jungle where there isn’t easy access to walking or running paths, then your efforts are being thwarted by your environment. If you are trying to make healthier food selections, but you only have fast food and small corner markets with limited produce and unprocessed food offerings, then you will likely struggle to meet nutrition standards necessary to manage your weight and diabetes.
The study looked at what’s called longitudinal associations between specific residential factors and glycemic control among 182,756 New York City residents diagnosed with diabetes, over a period of six years (2007 to 2013). Researchers defined glycemic control as an HbA1c level of less than 7 percent. A residential composite score was developed to reflect the presence or absence of certain neighborhood features including more advantaged socioeconomic conditions, a greater ratio of healthy to unhealthy food outlets, and residential walkability.
The researchers observed that the more advantaged the neighborhood, with more healthy food options and access to safe, easy-to-access walking opportunities, the better glycemic control achieved by subjects.
Conclusions from the study included:
- Living in a disadvantaged residential neighborhood is at odds with efforts to achieve optimal glycemic control.
- Moving from a less advantaged neighborhood to a more advantaged neighborhood with better healthy food and walking opportunities resulted in improved glycemic control in participating subjects.
- Moving from a more advantaged to a less advantaged neighborhood resulted in a shift in glycemic control with a higher HbA1c (negative impact).
The study found that subjects living in advantageous neighborhoods were more likely to achieve glycemic control compared to the subjects who lived in the least advantaged neighborhoods. Those in the most advantaged neighborhoods also optimized glycemic control in a shorter period compared to those living in the least advantaged neighborhoods.
In 2006, the New York City Department of Health and Mental Hygiene started a program requiring mandatory reporting of HbA1c results to an A1C Registry which allowed for public record keeping and health surveillance of people diagnosed with diabetes. They defined a “diagnosis of diabetes” with two A1C tests showing results of 6.5 percent or higher. New York City adults eighteen years of age or older in the new registry, who had a minimum of one A1C test yearly between 2007 and 2013 were included in the study.
Socioeconomic issues may contribute significantly to the big divide between achieving optimal management of diabetes versus even struggling to hit less than stellar HbA1c goals. That’s not to say that some people who live in advantaged neighborhoods with access to robust levels of healthy produce and loads of outdoor fitness opportunities all engage in best practices for achieving optimal glycemic control. On the contrary, I’ve had clients over the years who “don’t have time to shop” and mostly consume fast food, or people who can’t break away to fit exercise into their daily “hectic” routine despite living in affluent neighborhoods. Being advantaged doesn’t always translate into compliance and devotion to lifestyle action plans – even when it comes to health. By the same token, some people in disadvantaged situations can be very motivated and creative – exercising at home with minimal equipment and shopping far from their home for affordable, healthier foods on sale like day old whole grain baked bread and bruised fruit.
But you can’t argue with the study findings which suggest that given the two scenarios, having an environment that supports efforts to manage diabetes will likely help more people to achieve better control of their chronic condition. So how can you outsmart a disadvantaged living circumstance?
You can exercise at home with inexpensive free weights, resistance bands in different strengths, a jump rope, and use your own body weight to do pushups in a variety of positions, lunges, squats, plie squats, and a host of other challenging routines.
If you plan your shopping needs you can shop bulk once-a-week at warehouse supermarkets and car pool with a neighbor or friend if you don’t have a car. Many of these large shopping outlets are near a bus stop or subway so if you use a shopping cart on wheels you will also get a bit of a workout.
Food pantries are now stocking produce and healthier canned and boxed goods – beans, fish, high protein pasta, and nuts. Find out what your local pantry has.
Local community centers like the YMCA often subsidize a memberships or class prices.
Your insurance may provide coverage for sessions with a diabetes educator who may have coupons and other relationships that can help you to access affordable healthy food items and exercise opportunities.
Consider buddying up with co-workers to do workouts on your lunch hour, host a food swap, or use online support for nutrition and exercise ideas.