Abstract
On any given night in the United States, an estimated 553,742 people are homeless.
Applying a broader definition of homelessness that includes unstably housed people,
an estimated 1.5% of Americans experience homelessness in a given year. Rates of diabetes
are increasing among individuals experiencing homelessness. The social, psychological,
and physical challenges of homelessness not only contribute to the rate of diabetes,
but also complicate management. Unstable housing, limited medical resources, food
insecurity, and competing priorities are barriers to diabetes care among patients
experiencing homelessness. Homeless patients with diabetes more frequently develop
specific comorbidities that require special attention, such as cardiovascular disease,
substance abuse, depression, and foot wounds. The Affordable Care Act gave states
the option to expand Medicaid to those earning up to 138% of the federal poverty level.
This addressed a gap in coverage for low-income individuals not eligible for Medicaid
or employer-sponsored insurance. With increased insurance coverage, this has increased
the variety of medications available to treat hyperglycemia from type 2 diabetes beyond
metformin, sulfonylureas, and insulin. Several of the newer classes of medications
have advantages for patients experiencing homelessness, but also have special considerations
in this vulnerable patient population. This narrative review will provide a review
of dipeptidyl peptidase-4 inhibitors, glucagon-like peptide agonists, sodium glucose
cotransporter-2 inhibitors, and thiazolidinediones in individuals experiencing homelessness.
Keywords
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Article info
Publication history
Published online: November 22, 2018
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.
Identification
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© 2018 Elsevier Inc. All rights reserved.
