Exploring the association of social connections and food security among adults with uncontrolled type 2 diabetes: a population-based study

Background: Primary health care professionals are held accountable for various quality measures in the treatment of patients with chronic diseases such as diabetes. Uncontrolled type 2 diabetes (T2D) remains a considerable health problem; thus, further studying patients with this condition is important for delivering effective interventions. Social determinants of health (SDoH) have been shown to affect various aspects of diabetes care in different subpopulations. We studied the association of SDoH with uncontrolled T2D in a population of adult primary care patients. Methods: We retrospectively searched our electronic health record for adult patients (>= 18 years) with a diagnosis of T2D and a hemoglobin A(1c) (HbA(1c)) level of 8% or higher. Patients were empaneled to 2 primary care clinic sites between January 1, 2021, and January 31, 2022. Patients were grouped by HbA(1c) level to stratify patients according to the extent of uncontrolled T2D. Patient characteristics were compared among groups. Unadjusted and adjusted multinomial logistic regression analysis was used to estimate the odds of various SDoH factors among patient groups with different levels of uncontrolled T2D. Results: The study cohort included 1,596 patients. Most patients were White (79%), and the median age was 58.8 years. The median HbA(1c) level was 8.9%, and approximately 68% of patients were obese (body mass index [BMI] >= 30). When the study population was grouped by HbA(1c) level (8% to < 9% [n = 806], >= 9% to < 12% [n = 684], and >= 12% [n = 106]), significant differences among groups were observed in age group (P < .001), marital status (P < .001), race (P < .001), ethnicity (P = .001), and BMI category (P = .01). In groups with higher HbA(1c) levels, we noticed a higher percentage of patients who were aged 51 to 65 years or single. Among patients with uncontrolled HbA(1c) levels, more patients were obese than overweight. Patients in the intermediate HbA(1c) group had increased odds of food insecurity and some decreased social connections, even after adjusting for age, sex, race, ethnicity, and marital status. Conclusions: Among patients with uncontrolled T2D, higher HbA(1c) levels were associated with decreased social connections and increased food insecurity. Our findings provide insight into the role of these SDoH in managing T2D and have important implications for primary care practice.