The research is clear. Not everyone living with type 1 diabetes (T1D) has access to the same treatment resources. This includes diabetes devices and medications many of us take for granted, such as insulin, continuous glucose monitoring (CGM), and automated insulin delivery (AID) systems. 

As a T1D-specific mental health provider, I see these disparities firsthand in my work and how they affect a person’s physical and psychological well-being.  

While the greater diabetes community works together through research, advocacy, and implementing strategies to create a more inclusive healthcare system, we also need a larger focus on whole-person health for those living with diabetes, including their emotional well-being. 

 

Why is health equity important?

Health equity is vital to ensure everyone has the opportunity to be as healthy as possible, regardless of their background or circumstance. The Centers for Disease Control and Prevention (CDC) defines health equity as “a state in which everyone has a fair and just opportunity to attain their highest level of health.”  

From access to medications (including insulin) to diabetes technology and diabetes-specific mental health support, moving towards health equity means ensuring you receive whole-person care that considers all the factors contributing to your health and wellness. 

 

Health equity in T1D 

For many individuals living with T1D, health disparities can have a significant impact on their mental health. In my work as a psychologist, part of the support I provide is for the associated stress caused by a lack of access to proper healthcare resources.  

I recently worked with a person who lives with T1D, and they did not have access to an endocrinologist. As a result, they didn’t receive thorough T1D education and were unsure how to properly bolus insulin for meals. In turn, this significantly contributed to their anxiety and amounted to dangerously high glucose levels. 

This person is not alone. Research suggests that health disparities not only make it more challenging to manage diabetes, but they can also impact a person’s mental well-being.  

 

What inequities exist in diabetes care? 

A recent study by the T1D Exchange Quality Improvement Collaborative (T1DX-QI) shows that among the 1.6 million people in the United States who have T1D, treatment outcomes vary among different racial and ethnic groups.  

This study found that Hispanic and non-Hispanic Black people with T1D often have higher Hemoglobin A1C levels compared to non-Hispanic White people. Also, non-Hispanic Black people are more likely to face serious diabetes-related issues such as diabetic ketoacidosis (DKA) and severe low glucose events, in addition to a higher risk of death from diabetes-related complications. 

These study results suggest there’s a measurable difference in diabetes care across different racial and ethnic communities, which affects the health of individuals who live with T1D. 

 

Why should mental health care be accessible to everyone with T1D? 

The daily tasks involved in managing T1D, such as glucose monitoring, taking insulin, and staying active, can be overwhelming — and people may feel unmotivated, anxious, and even burned out. 

That’s why talking to your healthcare provider about your mental well-being and advocating for your needs to be met is so important. With life-long conditions like diabetes, the emotional burden can affect your physical health, too. 

In other words, with proper mental health care, you’ll be better equipped to handle the daily stressors of T1D. It can also help with glucose management and improve your quality of life. 

 

Health equity and mental health care in T1D 

Health disparities in people living with T1D extend beyond access to social needs and resources. Different racial and ethnic groups with diabetes also experience different mental health outcomes. 

According to research, these differences appear in several areas and are why everyone with diabetes should have access to mental health support. They include: 

  • Levels of stress about diabetes 
  • Feelings of depression 
  • Confidence in managing diabetes 
  • Support from others 

Keep in mind, that “support” does not necessarily mean seeing a mental health professional. It can also include diabetes education, stress management techniques (i.e., mindfulness, breathing), and being welcomed into the diabetes community (both online and in-person). 

Everyday life with T1D can be stressful. You may be feeling frustrated, anxious, or just plain “done” with diabetes. These feelings are entirely normal, and it’s why working toward equity in mental health care is so important. 

 

How can disparities be reduced — and what it means for you

Everyone can play a role in reducing disparities in diabetes care. Here are some things you can do. 

  • Advocate for Yourself. You are the best person to let your providers know what you need. If you get pushback, keep asking! 
  • Be Open with Your Care Team. Honesty is the best policy. Consider sharing what’s going on in your life with your diabetes care team. Without this information, they cannot help you overcome barriers. 

 

Understanding the impact of health inequities on the psychological well-being of people with T1D is crucial for improving overall health outcomes. As a person living with T1D, there are several important takeaways to keep in mind: 

  • Understand health disparities. Be aware that health disparities exist and can affect treatment outcomes. Understanding these disparities can help you advocate for more equitable healthcare and support others facing similar challenges. 
  • Advocacy is key. Your voice is powerful. When you speak up, your care team will listen to your questions and concerns. 
  • Mental health matters. Because emotional health can impact physical health, it’s essential to ask for the support you may need.