Social determinants of health in adults with type 2 diabetes-Contribution of mutable and immutable factors

Aims: Socioeconomic, psychosocial, and neighborhood factors influence clinical outcomes and self-care behaviors in diabetes; however, few studies simultaneously assessed the impact of multiple social determinant of health factors on glycemic control. We used an explanatory model to examine the differential contribution of social determinants and clinical factors on glycemic control. Secondarily, we examined the contribution of mutable and immutable factors to identify meaningful future interventions. Methods: Six hundred and fifteen adults with type 2 diabetes in the southeastern United States were recruited. A hierarchical model was run with HbA1c as the dependent variable and independent variables entered in blocks: demographics (block 1), socioeconomic (block 2), psychosocial (block 3), built environment (block 4), clinical (block 5), and knowledge/self-care (block 6). Results: Significant associations for HbA1c included self-efficacy (β = -0.10, p < 0.001), social support (β = 0.01, p < 0.05), comorbidity (β = -0.09, p < 0.05), insulin use (β = 0.95, p < 0.001), medication adherence (β = -0.11, p < 0.05), and being a former smoker (β = 0.34, p < 0.05); accounting for 24.4% of the variance. Conclusions: Important factors that drive glycemic control are mutable, and amenable to health interventions. Greater attention should be given to interventions that increase self-efficacy and social support, reduce the burden of comorbidities, and enhance medication adherence and smoking cessation.