Impact of Hurricane Matthew on Diabetes Self-management and Outcomes

Individuals with diabetes require extensive self-management. Little is known about how a hurricane impacts diabetes self-management or outcomes and how it perpetuates health disparities in Robeson County, NC, a county where there is a high proportion of minority racial groups. Mixed methods were used to assess the impact of hurricanes on diabetes outcomes. Mean hemoglobin A1c (HbA1c) and frequency of diabetic ketoacidosis (DKA) from the Southeastern Regional Medical Center from 6 months before and after Hurricane Matthew (HM) were compared using Student t-tests. Individuals with diabetes ≥ age 18 in Robeson County were recruited for focus groups and administered questionnaires to understand the perceived impact of the hurricane on diabetes self- management. Healthcare providers were recruited for parallel key informant interviews. 3,057 and 2,941 individuals had HbA1c measures available before and after HM, respectively. A demographic breakdown of 34.3% White, 21.7% Black or African American, and 21.4% American Indian or Alaska Native was observed in the sample representing 6 months after HM. No significant differences were found between mean HbA1c values before and after HM (before HM: mean HbA1c 8.34 ± 1.87%; after HM: mean HbA1c 8.31 ± 1.93 %; p=0.366). The period prevalence (PP) of DKA was higher in the 6 months after HM than before (before HM: 39 cases out of 4,025 visits, PP=0.010; after HM: 87 cases out of 3,779 visits, PP=0.023; p<0.0001). Significant themes from preliminary qualitative results highlight a lack of access to a balanced diet and diabetes medications that occurs during hurricanes in Robeson County, NC, especially for those of low socioeconomic position (SEP). Individuals with diabetes were more likely to experience DKA after Hurricane Matthew than before. Future interventions may improve outcomes via increased access to healthful foods and diabetes medications, particularly for those of low SEP.Bachelor of Science in Public Healt