Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; OCHIN Inc., Portland, Oregon.
Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon.
Am J Prev Med. 2022 Sep;63(3):392-402. doi: 10.1016/j.amepre.2022.03.011. Epub 2022 May 4.
Social risks (e.g., food/transportation insecurity) can hamper type 2 diabetes mellitus (T2DM) self-management, leading to poor outcomes. To determine the extent to which high-quality care can overcome social risks' health impacts, this study assessed the associations between reported social risks, receipt of guideline-based T2DM care, and T2DM outcomes when care is up to date among community health center patients.
A cross-sectional study of adults aged ≥18 years (N=73,484) seen at 186 community health centers, with T2DM and ≥1 year of observation between July 2016 and February 2020. Measures of T2DM care included up-to-date HbA1c, microalbuminuria, low-density lipoprotein screening, and foot examination, and active statin prescription when indicated. Measures of T2DM outcomes among patients with up-to-date care included blood pressure, HbA1c, and low-density lipoprotein control on or within 6‒12 months of an index encounter. Analyses were conducted in 2021.
Individuals reporting transportation or housing insecurity were less likely to have up-to-date low-density lipoprotein screening; no other associations were seen between social risks and clinical care quality. Among individuals with up-to-date care, food insecurity was associated with lower adjusted rates of controlled HbA1c (79% vs 75%, p<0.001), and transportation insecurity was associated with lower rates of controlled HbA1c (79% vs 74%, p=0.005), blood pressure (74% vs 72%, p=0.025), and low-density lipoprotein (61% vs 57%, p=0.009) than among those with no reported need.
Community health center patients received similar care regardless of the presence of social risks. However, even among those up to date on care, social risks were associated with worse T2DM control. Future research should identify strategies for improving HbA1c control for individuals with social risks.
This study is registered at www.
gov NCT03607617.
社会风险（例如，食物/交通不安全）可能会阻碍 2 型糖尿病（T2DM）的自我管理，导致不良后果。为了确定高质量的护理在多大程度上可以克服社会风险对健康的影响，本研究评估了报告的社会风险、接受基于指南的 T2DM 护理之间的关联，以及当社区卫生中心患者的护理是最新时 T2DM 结果。
这是一项横断面研究，纳入了 2016 年 7 月至 2020 年 2 月期间在 186 家社区卫生中心就诊的年龄≥18 岁的成年人（N=73484），患有 T2DM 且观察时间≥1 年。T2DM 护理的测量指标包括最新的糖化血红蛋白、微量白蛋白尿、低密度脂蛋白筛查和足部检查，以及在需要时积极开具他汀类药物。在接受最新护理的患者中，T2DM 结果的测量指标包括血压、HbA1c 和低密度脂蛋白控制情况，在指数就诊后 6-12 个月内或之内。分析于 2021 年进行。
报告交通或住房不安全的个体不太可能进行最新的低密度脂蛋白筛查；在社会风险和临床护理质量之间没有其他关联。在接受最新护理的个体中，食物不安全与较低的调整后 HbA1c 控制率相关（79% vs 75%，p<0.001），交通不安全与较低的 HbA1c 控制率相关（79% vs 74%，p=0.005），血压（74% vs 72%，p=0.025）和低密度脂蛋白（61% vs 57%，p=0.009），而与未报告需求的个体相比。
社区卫生中心患者接受的护理相同，无论是否存在社会风险。然而，即使在接受最新护理的患者中，社会风险也与较差的 T2DM 控制相关。未来的研究应该确定改善有社会风险个体的 HbA1c 控制的策略。
本研究在 www.clinicaltrials.gov 上注册。NCT03607617。
