Increased Social Vulnerability Accounted for Decrease in Diabetes Control

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In an abstract presented at the Endocrine Society’s ENDO 2024 annual meeting in Boston, Massachusetts, researchers addressed the association between social vulnerability and glycemic control in patients with diabetes.

Populations that experience high levels of social vulnerability are more likely to worsen control over HbA1c levels, while people of color and non-White populations from lower income areas are also less likely to maintain glycemic control, showing further racial disparities within the subject of diabetes management.

“According to the CDC, 29.7 million Americans are diagnosed with diabetes, contributing to morbidity, mortality, and strain on the health care system. In populations with lower educational attainment levels, lower income, and higher rates of poverty, prevalence of [diabetes] and rates of complications are higher,” wrote authors of the abstract presented at ENDO 2024.1

Key Takeaways

  • Researchers addressed the association between social vulnerability and glycemic control in patients with diabetes.
  • They found that as social vulnerability increased, diabetes control was more and more difficult to maintain
  • People of color and non-White populations also experienced further disparities regarding glycemic control.

In the study, researchers used national Healthcare Effectiveness Data and Information Set standards for proper glycemic control at least under 8% and the social vulnerability index (SVI) to measure individuals’ social vulnerabilities. SVI is calculated based on variables and themes such as socioeconomic status, household characteristics, racial/ethnic minority status, and housing/transportation.1

While other studies have compared access to health care and behavioral habits with glycemic control, previous literature supports the association between low socioeconomic status and poor diabetes management.2

According to the CDC, 29.7 million Americans are diagnosed with diabetes, contributing to morbidity, mortality, and strain on the health care system. | image credit: Suriyawut / stock.adobe.com

According to the CDC, 29.7 million Americans are diagnosed with diabetes, contributing to morbidity, mortality, and strain on the health care system. | image credit: Suriyawut / stock.adobe.com

Researchers aimed to further assess these potential associations using what they called social detriments of health (SDOH) and their impact on diabetes management. The SDOH categories included socioeconomic detriments including food, housing, and transportation insecurities.1

Study participants included 26,010 diabetes patients located in Upstate New York. The researchers found patients’ SVI scores—ranging from 0 to 1, or lowest to highest vulnerability—measured their SDOH, and finally separated each participant by race.

“Within each racial category, diabetes control rates worsened with increasing SVI,” they wrote.

Amongst the study population, 73.6% of patients were able to control HbA1c levels to under 8%. When stratified by race, this accounted for 75.7% of White participants, 66.1% of Black participants, 75.2% of Asian participants, and 67.3% of participants identifying with other races.1

READ MORE: Diabetes Resource Center

With participants identifying as White and Asian demonstrating higher glycemic control, findings confirm the racial disparities in diabetes management.

Furthermore, they compared the ability to control HbA1c between those who did and did not express food, housing, or transportation insecurities. The researchers found further disparities in all 3 categories: 79.8% with no food insecurity controlled HbA1c compared with 67.7%; 80.1% with no housing insecurity compared with 66.0%; and 79.2% with no transportation insecurity compared with 67.7% with unmet transportation needs.1

“Across a large sample of patients with diabetes, increasing [social vulnerability] was associated with worsening glycemic control across all racial groups studied. Both race and SVI were independently associated with DM control. SVI did not fully mitigate the influence of race on DM control. Within a given SVI category, non-White participants had worse diabetic control than White participants,” wrote the authors.1

Further breaking down associations between overall diabetes control and socioeconomic status, results highlighted in the abstract further reinforce the need for more attention and resources in highly vulnerable communities.

Previous studies have shown that “poor health-related behaviors and limited access to healthcare are the pathways by which low [socioeconomic status] may contribute to diabetes.”2

The presented research reinforces and reconfirms previous literature that lower socioeconomic populations and locations suffer from more detrimental diabetes control. It is part of a long line of sentiments that these same locations and populations need and deserve better education, resources, and attention to improve these racial and economic disparities.

“These findings highlight the importance of social vulnerability and social determinants of health on the control of diabetes. These findings further depict the persistent racial disparities across the spectrum of social vulnerability,” said study author Jennifer Tich, MD, a third-year internal medicine-pediatrics resident said in an Endocrine Society news release.3

Click here for more of our coverage from ENDO 2024.

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References
1. Tich J, MacLeod SR, Zhang V, et al. Impact of social vulnerability on glycemic control in primary care patients with diabetes. Presented at: ENDO 2024; June 1-4; Boston, MA.
2. Liu C, He L, Li Y, et al. Diabetes risk among US adults with different socioeconomic status and behavioral lifestyles: evidence from the National Health and Nutrition Examination Survey. Front Public Health. 2023;11:1197947. doi.org/10.3389/fpubh.2023.1197947
3. Race and social vulnerability impact glycemic control in people with diabetes. News release. The Endocrine Society. June 2, 2024. Accessed June 5, 2024.
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