%0 Journal Article
%@ 2561-326X
%I JMIR Publications
%V 6
%N 10
%P e40164
%T Social Determinants of Health and Diabetes-Related Distress in Patients With Insulin-Dependent Type 2 Diabetes: Cross-sectional, Mixed Methods Approach
%A Levy,Natalie K
%A Park,Agnes
%A Solis,Daniela
%A Hu,Lu
%A Langford,Aisha T
%A Wang,Binhuan
%A Rogers,Erin S
%+ Department of Medicine, New York University Grossman School of Medicine, 462 First Ave, New York, NY, 10016, United States, 1 212 263 8924, natalie.levy@nyulangone.org
%K social determinants of health
%K income
%K socioeconomic
%K cross sectional
%K insulin
%K diabetic
%K HbA1c
%K barrier
%K diabetes-related distress
%K type 2 diabetes
%K ambulatory care
%K healthcare
%K health care
%K distress
%K epidemiology
%K T2DM
%K diabetes
%D 2022
%7 12.10.2022
%9 Original Paper
%J JMIR Form Res
%G English
%X 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 A1c 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. 
%M 36222807
%R 10.2196/40164
%U https://formative.jmir.org/2022/10/e40164
%U https://doi.org/10.2196/40164
%U http://www.ncbi.nlm.nih.gov/pubmed/36222807