Type 2 diabetes management in the homeless population: health inequality and the Housing First approach

Abstract

Homelessness is a significant public health concern, with a substantial homeless population in England. Homeless individuals face unique challenges, including a heightened risk of violence, inadequate nutrition, limited healthcare access and increased prevalence of co-morbidities. Type 2 diabetes (T2DM) is notably more prevalent among homeless individuals compared to the general population, leading to higher rates of diabetes-related emergency department visits and hospitalisations. There is limited research examining diabetes management specifically in homeless populations, and a comprehensive review addressing the barriers and targeted interventions for this vulnerable group is currently lacking. This article aims to explore the health inequalities experienced by homeless individuals in relation to T2DM management, and to evaluate the Housing First approach as a potential intervention. Housing First, which provides immediate access to permanent housing, has demonstrated efficacy in enhancing housing stability and healthcare behaviours among homeless populations. Moreover, the available evidence suggests that Housing First programmes may improve diabetes-related outcomes, including HbA1c testing and medication adherence, and may lead to fewer hospitalisations.