Population Health

Social Needs Impact on Diabetes Management

JAMA Network Open

New research published in JAMA Network Open found that health-related social needs (HRSNs) have a major impact on both quality and utilization outcomes for people with type 2 diabetes.

Using self-reported data from a national sample of 21,528 Medicare Advantage beneficiaries with T2D, researchers found that the majority (56.9%) reported at least one HRSN, and that each one significantly affected outcomes.

Here’s a look at the odds ratio impact of HRSNs on diabetes medication adherence (proportion of days covered over 80%), statin adherence (PDC over 80%), and having controlled HbA1c. Not too surprising to see that financial strain had the largest negative impact on HbA1c control.

  • Food insecurity – Diabetes (0.93), Statin (1.02), HbA1c (1.02)
  • Financial strain – Diabetes (0.91), Statin (0.91), HbA1c (0.83)
  • Loneliness – Diabetes (0.85), Statin (0.79), HbA1c (0.96)
  • Unreliable transport – Diabetes (0.80), Statin (0.80), HbA1c (0.94)
  • Housing insecurity – Diabetes (0.78), Statin (0.96), HbA1c (0.92)

Each of the five HRSNs also influenced hospital utilization, and it was interesting that food insecurity was identified as the factor with the largest impact on acute care usage. Here are the changes in utilization per 1,000 MA enrollees for avoidable hospitalizations, ED visits, inpatient encounters, and 30-day readmissions.

  • Food insecurity – Hospitalization (17.1), ED Visit (84.6), IE (30.4), Readmission (8.2)
  • Financial strain – Hospitalization (4.6), ED Visit (40), IE (6.8), Readmission (2.3)
  • Loneliness – Hospitalization (3.9), ED Visit (173), IE (-6.3), Readmission (-4.5)
  • Unreliable transport – Hospitalization (13.5), ED Visit (244.6), IE (41.8), Readmission (1)
  • Housing insecurity – Hospitalization (6.3), ED Visit (55.4), IE (16.1), Readmission (10.2)

The Takeaway

Type 2 diabetes affects more than a quarter of people above age 65 while costing the US health system over $200B each year, and this study underscores the significant role that HRSNs play in managing the disease. Much of the existing work around HRSNs relies on area-level social needs measures because patient-level data is hard to come by, but these findings suggest that collecting patient data is worth the effort to move the needle in diabetes care.

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