Cross-Sectional Associations: Social Risks and Diabetes Care Quality, Outcomes

Rachel Gold, Jorge Kaufmann, Laura M. Gottlieb, Saul J. Weiner, Megan Hoopes, Jordan C. Gemelas, Cristina Huebner Torres, Erika K. Cottrell, Danielle Hessler, Miguel Marino, Christina R. Sheppler, Seth A. Berkowitz

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Social risks (e.g., food/transportation insecurity) can hamper type 2 diabetes mellitus self-management, leading to poor outcomes. To determine the extent to which high-quality care can overcome social risks’ health impacts, this study assessed the associations between reported social risks, receipt of guideline-based type 2 diabetes mellitus care, and type 2 diabetes mellitus outcomes when care is up to date among community health center patients. Methods: A cross-sectional study of adults aged ≥18 years (N=73,484) seen at 186 community health centers, with type 2 diabetes mellitus and ≥1 year of observation between July 2016 and February 2020. Measures of type 2 diabetes mellitus care included up-to-date HbA1c, microalbuminuria, low-density lipoprotein screening, and foot examination, and active statin prescription when indicated. Measures of type 2 diabetes mellitus outcomes among patients with up-to-date care included blood pressure, HbA1c, and low-density lipoprotein control on or within 6‒12 months of an index encounter. Analyses were conducted in 2021. Results: Individuals reporting transportation or housing insecurity were less likely to have up-to-date low-density lipoprotein screening; no other associations were seen between social risks and clinical care quality. Among individuals with up-to-date care, food insecurity was associated with lower adjusted rates of controlled HbA1c (79% vs 75%, p<0.001), and transportation insecurity was associated with lower rates of controlled HbA1c (79% vs 74%, p=0.005), blood pressure (74% vs 72%, p=0.025), and low-density lipoprotein (61% vs 57%, p=0.009) than among those with no reported need. Conclusions: Community health center patients received similar care regardless of the presence of social risks. However, even among those up to date on care, social risks were associated with worse type 2 diabetes mellitus control. Future research should identify strategies for improving HbA1c control for individuals with social risks. Trial Registration: This study is registered at www.clinicaltrials.gov NCT03607617.

Original languageEnglish (US)
JournalAmerican journal of preventive medicine
DOIs
StateAccepted/In press - 2022

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Fingerprint

Dive into the research topics of 'Cross-Sectional Associations: Social Risks and Diabetes Care Quality, Outcomes'. Together they form a unique fingerprint.

Cite this