Quantifying direct effects of social determinants of health on glycemic control in adults with type 2 diabetes.

Walker RJ, Gebregziabher M, Martin-Harris B, Egede LE. Quantifying direct effects of social determinants of health on glycemic control in adults with type 2 diabetes. Diabetes Technology & Therapeutics. 2015 Feb 1; 17(2):80-7.

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Abstract:

BACKGROUND: The aim of this study was to investigate if self-care is the pathway through which social determinants of health impact diabetes outcomes by analyzing the direct and indirect effects of socioeconomic and psychosocial factors on self-care and glycemic control. SUBJECTS AND METHODS: Six hundred fifteen adults were recruited from two primary care clinics in the southeastern United States. A series of confirmatory factor analyses identified the latent factors underlying social status, psychosocial determinants (psychological distress, self-efficacy, and social support), and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling investigated the relationship among social determinants, self-care and glycemic control. RESULTS: Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support, and social status. The final model [?(2)(275) = 450.07, P < 0.001, R(2) = 99, root mean square error of approximation = 0.03, comparative fit index = 0.98] showed lower psychological distress (r = -0.13, P = 0.012), higher social support (r = 0.14, P = 0.01), and higher self-efficacy (r = 0.47, P < 0.001) were significantly related to diabetes self-care. Lower psychological distress (r = 0.10, P = 0.03), lower social support (r = 0.10, P = 0.02), and higher self-efficacy (r = -0.37, P < 0.001) were significantly related to lower glycemic control. When social determinants of health variables were included in the model, self-care was no longer significantly associated with glycemic control (r = 0.01, P = 0.83). CONCLUSIONS: This study suggests a direct relationship between psychosocial determinants of health and glycemic control. Although associated with self-care, the relationship between social determinants of health and glycemic control is not mediated by self-care. Development of interventions should take psychosocial factors into account as independent influences on diabetes outcomes, rather than as indirect influences via self-care behavior.