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

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.