Exploring the association of social connections and food security among adults with uncontrolled type 2 diabetes: a population-based study.

IF 2.4 3区 医学 Q3 ENVIRONMENTAL SCIENCES
Ramona S DeJesus, Jessica A Grimm, Chun Fan, Jennifer St Sauver
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引用次数: 0

Abstract

Background: Primary health care professionals are held accountable for various quality measures in the treatment of patients with chronic diseases such as diabetes. Uncontrolled type 2 diabetes (T2D) remains a considerable health problem; thus, further studying patients with this condition is important for delivering effective interventions. Social determinants of health (SDoH) have been shown to affect various aspects of diabetes care in different subpopulations. We studied the association of SDoH with uncontrolled T2D in a population of adult primary care patients.

Methods: We retrospectively searched our electronic health record for adult patients (≥18 years) with a diagnosis of T2D and a hemoglobin A1c (HbA1c) level of 8% or higher. Patients were empaneled to 2 primary care clinic sites between January 1, 2021, and January 31, 2022. Patients were grouped by HbA1c level to stratify patients according to the extent of uncontrolled T2D. Patient characteristics were compared among groups. Unadjusted and adjusted multinomial logistic regression analysis was used to estimate the odds of various SDoH factors among patient groups with different levels of uncontrolled T2D.

Results: The study cohort included 1,596 patients. Most patients were White (79%), and the median age was 58.8 years. The median HbA1c level was 8.9%, and approximately 68% of patients were obese (body mass index [BMI] ≥30). When the study population was grouped by HbA1c level (8% to < 9% [n = 806], ≥9% to < 12% [n = 684], and ≥12% [n = 106]), significant differences among groups were observed in age group (P < .001), marital status (P < .001), race (P < .001), ethnicity (P = .001), and BMI category (P = .01). In groups with higher HbA1c levels, we noticed a higher percentage of patients who were aged 51 to 65 years or single. Among patients with uncontrolled HbA1c levels, more patients were obese than overweight. Patients in the intermediate HbA1c group had increased odds of food insecurity and some decreased social connections, even after adjusting for age, sex, race, ethnicity, and marital status.

Conclusions: Among patients with uncontrolled T2D, higher HbA1c levels were associated with decreased social connections and increased food insecurity. Our findings provide insight into the role of these SDoH in managing T2D and have important implications for primary care practice.

探索未受控制的 2 型糖尿病成人患者的社会关系与食品安全之间的关联:一项基于人群的研究。
背景:在治疗糖尿病等慢性病患者的过程中,初级医疗保健专业人员需要对各种质量措施负责。未得到控制的 2 型糖尿病(T2D)仍然是一个严重的健康问题;因此,进一步研究该病患者对于提供有效的干预措施非常重要。健康的社会决定因素(SDoH)已被证明会影响不同亚人群糖尿病护理的各个方面。我们研究了成人初级保健患者中 SDoH 与未控制的 T2D 之间的关系:我们回顾性地搜索了电子健康记录中诊断为 T2D 且血红蛋白 A1c (HbA1c) 水平达到或超过 8% 的成年患者(≥18 岁)。患者在 2021 年 1 月 1 日至 2022 年 1 月 31 日期间被派往 2 个初级保健诊所。根据 HbA1c 水平对患者进行分组,以便根据 T2D 未控制的程度对患者进行分层。对各组患者的特征进行比较。采用未经调整和调整的多项式逻辑回归分析来估算不同T2D未控制程度的患者组别中各种SDoH因素的几率:研究队列包括 1,596 名患者。大多数患者为白人(79%),年龄中位数为 58.8 岁。HbA1c 中位数为 8.9%,约 68% 的患者为肥胖(体重指数 [BMI] ≥30)。按 HbA1c 水平(8% 至 1c 水平)对研究人群进行分组时,我们注意到 51 至 65 岁或单身患者的比例较高。在 HbA1c 水平未受控制的患者中,肥胖患者多于超重患者。即使在调整了年龄、性别、种族、民族和婚姻状况后,HbA1c 中等水平组患者的食物无保障几率也有所增加,社会关系也有所减少:在未得到控制的 T2D 患者中,较高的 HbA1c 水平与社会联系减少和食物无保障程度增加有关。我们的研究结果让人们深入了解了这些 SDoH 在控制 T2D 中的作用,对初级保健实践具有重要意义。
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来源期刊
Journal of Health, Population, and Nutrition
Journal of Health, Population, and Nutrition 医学-公共卫生、环境卫生与职业卫生
CiteScore
2.20
自引率
0.00%
发文量
49
审稿时长
6 months
期刊介绍: Journal of Health, Population and Nutrition brings together research on all aspects of issues related to population, nutrition and health. The journal publishes articles across a broad range of topics including global health, maternal and child health, nutrition, common illnesses and determinants of population health.
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