PMID- 36222807
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230523
IS  - 2561-326X (Electronic)
IS  - 2561-326X (Linking)
VI  - 6
IP  - 10
DP  - 2022 Oct 12
TI  - Social Determinants of Health and Diabetes-Related Distress in Patients With 
      Insulin-Dependent Type 2 Diabetes: Cross-sectional, Mixed Methods Approach.
PG  - e40164
LID - 10.2196/40164 [doi]
LID - e40164
AB  - BACKGROUND: Social determinants of health (SDOH) refer to the social, economic, 
      and psychosocial conditions that influence health. Lower levels of SDOH factors 
      including 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 mellitus (T2DM). OBJECTIVE: This 
      study aimed to identify the range of SDOH challenges-including diabetes-related 
      distress-that impact patients with insulin-dependent diabetes at an urban 
      safety-net clinic using the 5-domain SDOH framework developed by the Healthy 
      People 2020 initiative. METHODS: The pilot study used a cross-sectional, mixed 
      methods approach. Participants were recruited from 3 programs within a general 
      internal medicine clinic that provides ambulatory care for patients with 
      uncontrolled T2DM. We administered an investigator-developed SDOH survey based on 
      the Healthy People 2020 framework and the validated Diabetes Distress Scale 
      (DDS), which assesses 4 domains of diabetes-related distress. One-on-one 
      interviews were conducted to gain in-depth information about challenges. RESULTS: 
      In total, 57 participants had an average hemoglobin A(1c) level of 11.0% (SD 
      2.6%). Overall, 92% (52/57) of participants had a barrier in at least one SDOH 
      domain. SDOH challenges were most commonly reported in the domain of Health and 
      Health Care (84%, 48/57), followed by Economic Stability (54%, n=31), 
      Neighborhood and Built Environment (53%, n=30), Education and Health Literacy 
      (47%, n=27), and Social and Community context (37%, n=21). The mean overall DDS 
      score was 2.09 (SD 0.84), where scores of >/=2 indicate distress. Further, 79% 
      (45/57) of participants had at least moderate diabetes-related distress in one of 
      the 4 DDS domains. General themes that emerged from participant interviews 
      included job interference with healthy behaviors, concerns about burdening 
      others, challenges communicating with providers, and difficulty getting 
      appointments in a timely manner. CONCLUSIONS: We found high levels of SDOH 
      barriers across all 5 domains of the Center for Disease Control and Prevention'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.
CI  - (c)Natalie K Levy, Agnes Park, Daniela Solis, Lu Hu, Aisha T Langford, Binhuan 
      Wang, Erin S Rogers. Originally published in JMIR Formative Research 
      (https://formative.jmir.org), 12.10.2022.
FAU - Levy, Natalie K
AU  - Levy NK
AUID- ORCID: 0000-0003-2956-5876
AD  - Department of Medicine, New York University Grossman School of Medicine, New 
      York, NY, United States.
FAU - Park, Agnes
AU  - Park A
AUID- ORCID: 0000-0003-2870-3624
AD  - Department of Medicine, New York University Grossman School of Medicine, New 
      York, NY, United States.
FAU - Solis, Daniela
AU  - Solis D
AUID- ORCID: 0000-0002-5687-6533
AD  - Department of Medicine, New York University Grossman School of Medicine, New 
      York, NY, United States.
FAU - Hu, Lu
AU  - Hu L
AUID- ORCID: 0000-0002-2386-064X
AD  - Department of Population Health, New York University Grossman School of Medicine, 
      New York, NY, United States.
FAU - Langford, Aisha T
AU  - Langford AT
AUID- ORCID: 0000-0003-1758-691X
AD  - Department of Population Health, New York University Grossman School of Medicine, 
      New York, NY, United States.
FAU - Wang, Binhuan
AU  - Wang B
AUID- ORCID: 0000-0002-3435-3424
AD  - Department of Population Health, New York University Grossman School of Medicine, 
      New York, NY, United States.
FAU - Rogers, Erin S
AU  - Rogers ES
AUID- ORCID: 0000-0002-3207-7956
AD  - Department of Population Health, New York University Grossman School of Medicine, 
      New York, NY, United States.
LA  - eng
GR  - P30 DK111022/DK/NIDDK NIH HHS/United States
PT  - Journal Article
DEP - 20221012
PL  - Canada
TA  - JMIR Form Res
JT  - JMIR formative research
JID - 101726394
PMC - PMC9607916
OTO - NOTNLM
OT  - HbA1c
OT  - T2DM
OT  - ambulatory care
OT  - barrier
OT  - cross sectional
OT  - diabetes
OT  - diabetes-related distress
OT  - diabetic
OT  - distress
OT  - epidemiology
OT  - health care
OT  - healthcare
OT  - income
OT  - insulin
OT  - social determinants of health
OT  - socioeconomic
OT  - type 2 diabetes
COIS- Conflicts of Interest: None declared.
EDAT- 2022/10/13 06:00
MHDA- 2022/10/13 06:01
PMCR- 2022/10/12
CRDT- 2022/10/12 10:53
PHST- 2022/06/08 00:00 [received]
PHST- 2022/08/09 00:00 [accepted]
PHST- 2022/08/02 00:00 [revised]
PHST- 2022/10/12 10:53 [entrez]
PHST- 2022/10/13 06:00 [pubmed]
PHST- 2022/10/13 06:01 [medline]
PHST- 2022/10/12 00:00 [pmc-release]
AID - v6i10e40164 [pii]
AID - 10.2196/40164 [doi]
PST - epublish
SO  - JMIR Form Res. 2022 Oct 12;6(10):e40164. doi: 10.2196/40164.