Accepted for/Published in: JMIR Formative Research
Date Submitted: Jun 8, 2022
Date Accepted: Aug 9, 2022
Social Determinants of Health and Diabetes-Related Distress in Patients with Insulin-Dependent Type 2 Diabetes: A Cross-Sectional, Mixed Methods Approach
ABSTRACT
Background:
Social determinants of health (SDOH) refer to the social, economic and psychosocial conditions that influence health. Lower levels of SDOH factors like income, education, and employment are associated with a higher prevalence of diabetes, poorer glycemic control, and increased diabetes-related mortality. Few studies have conducted a comprehensive evaluation of multiple SDOH factors in a population with type 2 diabetes.
Objective:
To explore SDOH challenges, including diabetes-related distress, across the five domains outlined by the Centers for Disease Control and Prevention’s Healthy People 2020 initiative for patients with uncontrolled insulin-dependent diabetes at a safety-net clinic in New York City.
Methods:
The pilot study used a cross-sectional, mixed methods approach. Patients were recruited from three programs within a general internal medicine clinic that provides ambulatory care for patients with uncontrolled type 2 diabetes. We administered an investigator-developed SDOH survey based on the Healthy People 2020 framework and the validated Diabetes Distress Scale (DDS), which assesses four domains of diabetes-related distress. One-on-one interviews were conducted to gain in-depth information about challenges.
Results:
Fifty-seven participants had an average HbA1c of 11% (97 mmol/mol). Ninety-two percent of participants had a barrier in at least one SDOH domain. The most common SDOH barrier was in Health and Health Care (84%), followed by Economic Stability (54%), Neighborhood and Built Environment (53%), Education and Health Literacy (47%) and Social and Community context (37%). Seventy-nine percent of participants had at least moderate diabetes-related distress in one of the four DDS domains. Rich qualitative themes were learned.
Conclusions:
We found high levels of SDOH barriers across all 5 domains of the CDC’s Healthy People 2020 framework, including significant levels of diabetes-related distress. Future programs to address SDOH barriers in patients with uncontrolled insulin-dependent diabetes should consider screening for, and focusing on, a wide range of challenges.
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