Background: While it is recognized that underserved YA with T1D experience SDOH that contribute to adverse outcomes, it is unknown how often and what SDOH are most frequently experienced, or whether they interfere with self-management, which limits potential for intervention. Using EMA methods, we explored relationships between daily experience of SDOH and diabetes self-management. Methods: We recruited 61 underserved YA (18-30 yo) with T1D from the Bronx, New York. We prompted EMA surveys via smartphone 3 times daily over a 14-day period. We asked YA how SDOH interfered with self-management twice daily: “Since the last survey, which of the following life factors got in the way of your diabetes care today?”. Answer choices included money, food, housing, transportation, personal safety, mental health, and racial/ethnic or socioeconomic discrimination. Descriptive statistics were used to quantify and report frequency and variation of SDOH related care burden over the 14-day period. Results: Overall, 51 YA completed 778 EMA surveys over the 14-day period (23±4 yo, 65% F, 36% Black, 54% Hispanic, 73% Medicaid-insured, mean HbA1c 8.6%). Thirty-seven YA (73%) endorsed at least one daily SDOH related diabetes care burden, on an average of 22% of days. Mental health problems were reported most frequently (n=23 [62%], 11% of days), followed by transportation problems (n=17 [46%], 6% of days), and financial problems (n=15 (41%), 5% of days). The other SDOH choices accounted for less than 5% of responses. Conclusion: Using EMA to study SDOH in a short timeframe identified significant daily SDOH related diabetes care burdens in underserved YA with T1D. Mental health, transportation, and financial barriers prominently and frequently interfered, while others were described more sporadically albeit still present. SDOH need to be measured in new ways to better understand how and when to intervene to improve outcomes in underserved populations. Disclosure M.Finnan: None. C.Schechter: None. G.Crespo-ramos: None. C.J.Hoogendoorn: None. J.S.Gonzalez: Consultant; Virta Health Corp. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. Funding NY-Regional Center for Diabetes Translational Research (5P30DK111022-08); National Institute for Diabetes and Digestive and Kidney Diseases (K23DK115896-05)
Background: Underserved YA with T1D transitioning from pediatric to adult care experience adverse outcomes, which stem from simultaneously unmet social, glycemic, and health system navigation needs. We developed a multidisciplinary clinical program called SEAD to address these challenges. In this analysis, we compared outcomes in YA with TID who were enrolled in SEAD to comparable YA in non-SEAD usual care. Methods: The SEAD model was integrated into routine adult diabetes care at Montefiore in 2019, offering equal access to all YA with T1D aged 18-35 years old. SEAD provides YA-centered care, ongoing T1D education, diabetes technology support, psychological focus, and equity-based social need screening and referrals. We collected data prospectively on YA receiving care in SEAD vs. non-SEAD at Montefiore from 2019-2022 for a priori program evaluation, using multivariate linear regression to compare primary glycemic outcomes and Kaplan-Meier analysis for secondary technology outcomes, adjusted for age, sex, race/ethnicity, DKA, and complications. Results: We included 416 YA with T1D (SEAD n=244, non-SEAD n=172): mean age 23 ± 4y, 49% F, 35% Black, 47% Hispanic, 73% Medicaid-insured (no baseline differences, p>0.05). Compared to non-SEAD care, YA in SEAD care experienced double the HbA1c improvement with a cumulative effect size of -0.9% vs. -0.45% over the 3-year study period [SEAD: -0.30%/yr (-0.43, -0.18); non-SEAD: -0.15%/yr (-0.27, 0.04)], and had higher likelihood of accepting insulin pump (HR 1.96, [1.24, 3.12]) and CGM therapy (HR 1.63, [0.97, 2.72]). Conclusion: Integration of the SEAD model into adult diabetes care to offer YA-centered T1D and social needs support improved glycemic control and diabetes technology uptake for underserved YA with T1D, compared to usual care. Cumulative effects over time could change YA trajectories into adulthood. Disclosure S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. P.M.Mathias: None. C.Schechter: None. M.Greenberg: None. M.Finnan: None. J.A.Long: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896-05)
Background: While it is recognized that SDOH can impact diabetes self-management and glycemic control in underserved YA with T1D, the real-time dynamic interplay among these variables within a given individual is poorly understood, which limits intervention potential. Methods: We recruited 61 underserved YA with T1D (ages 18-30 yo) from the Bronx, New York. We administered 14 days of 3 times daily Ecological Momentary Assessment (EMA) surveys via smartphone, paired with blinded continuous glucose monitoring (CGM). Young adults reported twice daily on their experience of SDOH and once daily on their diabetes self-management. Using dynamic structural equation modeling, we evaluated within-person direct and indirect effects of SDOH on glycemic control, mediated through self-management. Results: We included 51 YA with complete data (mean age 23 yo, 36% Black, 54% Hispanic, 73% Medicaid-insured, mean A1c 8.6%). Within an individual, on days when reported, presence of SDOH predicted lower time in range (TIR, 70-180 mg/dl) by 0.8% and increased mean blood glucose by 1.7 mg/dl that same day, but only when diabetes self-management was affected (indirect pathway). Separately, on days when daily self-management rating was higher, regardless of whether SDOH were experienced, TIR (+6.3%) and mean blood glucose (-14 mg/dl) improved that same day. Conclusions: We examined the daily dynamic interplay of changes in SDOH, self-management, and glycemia in a novel way in underserved YA with T1D. While experiencing daily SDOH negatively affected glycemic control, it was only when self-management was also impacted. Just-in-time self-management support delivered in the context of daily SDOH experiences offers a new approach to timely targeted intervention. Interrupting the chronic cycle of cumulative effects of daily SDOH on glycemia could affect long-term outcomes. Disclosure G.Crespo-ramos: None. C.Schechter: None. M.Finnan: None. C.J.Hoogendoorn: None. J.S.Gonzalez: Consultant; Virta Health Corp. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. Funding NY-Regional Center for Diabetes Translational Research (5P30DK111022-08); National Institute for Diabetes and Digestive and Kidney Diseases (K23DK115896-05)
Objective: Although following a healthy diet is a key aspect of diabetes self-care, few brief, validated dietary measures exist. The 8-item Starting the Conversation (STC) questionnaire shows promise but has limited validation, particularly among Latinos, who are disproportionately impacted by T2D. Methods: We assessed the STC’s factor structure in English and Spanish, convergent and divergent validity, and internal reliability at baseline using data from 812 predominantly Latino adults with T2D who participated in a trial of telephonic self-management support (Female = 56.9%; Latino = 85.8%; Mean (SD) Age and A1C = 59.2 (10.8) , 9.3 (1.8) , respectively) . We also examined the STC’s sensitivity to this intervention over 12 months. Results: Exploratory factor analysis yielded 2 factors: Junk Food and Healthy Food. When 3 items were excluded due to low loadings, a single Junk Food factor was retained, explaining 40% of variance in STC scores. Cronbach’s alphas for the 5-item Junk Food scale were similar in Spanish (α = .61) and English (α = .57) at baseline. The Junk Food scale demonstrated convergent validity with BMI (r = .13, p < .001) and self-reported diabetes self-care (r = -.33, p < .001) , but not with A1C (r = .04, p = .328) , systolic BP (r = -.09, p = .011) , or diastolic BP (r = -.04, p = .312) . Demonstrating divergent validity, the Junk Food scale did not correlate with 4 scales assessing beliefs about medication (rs ≤ .06; ps ≥ .103) . There was no significant difference in change in Junk Food scores over time between the intervention and control arms (DID = -.02, SE = .03, , 95% CI [-.08, .04]) . Conclusions: Although the Junk Food scale demonstrates mixed evidence for convergent validity, this 5-item measure may provide a useful assessment of unhealthy food consumption among English- and Spanish-speakers with T2D. To our knowledge, this is the first study to investigate the factor structure of the STC, which may inform its utility for research and practice. Disclosure L.D.Pappalardo: None. C.Schechter: None. R.Fang: None. C.J.Hoogendoorn: None. J.S.Gonzalez: Consultant; Virta Health Corp. E.A.Walker: None. Funding National Institutes of Health (R18 DK098742) Einstein–Mount Sinai Diabetes Research Center (P30 DK020541) New York Regional Center for Diabetes Translation Research (P30 DK111022)
Objectives: Diabetes self-efficacy (confidence in ability to perform diabetes self-care) and personal control (perceived ability to influence diabetes outcomes) have been associated with better T2D self-care and health outcomes. Social cognitive theory posits that both beliefs are necessary for optimal initiation and maintenance of behavior change. However, their independent effects are unclear in T2D, especially in relation to dietary behaviors. We examined the independent associations of self-efficacy and personal control with junk food dietary patterns (JFDP) among predominantly Latino and disadvantaged adults with T2D and explored potential mediating effects. Methods: Adults with T2D (N = 812; Age = 59.2 (10.8) ; F = 57%; A1C = 9.3 (1.8) ; Latino = 86%; Spanish-speakers = 78.0%) enrolled in a trial of telephonic self-management support, completed self-report measures of diet (Starting the Conversation-STC) , diabetes self-efficacy, and diabetes personal control at baseline. A 5-item JFDP sub-scale of the 8-item STC was supported by factor analysis. Results: Unlike personal control (r = 0.10, 95% CI = -0.06, 0.08) , self-efficacy was inversely correlated with JFDP (r = -0.16, 95% CI = -0.23, -0.10) . In multivariable analysis, higher self-efficacy had a small independent association with less JFDP (b = -0.02, SE = 0.003, 95% CI = -0.02, -0.01) but perceived control did not (b = -0.04, SE = 0.15, 95% CI = -0.35, 0.29) . Mediation analyses showed no evidence for personal control as a mediator of the relationship between self-efficacy and JFDP. Conclusion: Among a predominantly Latino, disadvantaged adults with sub-optimally controlled T2D, diabetes self-efficacy was associated with lower reported consumption of junk foods, whereas no effect was observed for personal control. If these associations reflect causal relationships, interventions aiming to reduce junk food consumption in this vulnerable population may have more of an impact by targeting self-efficacy beliefs. Disclosure H.Mendez-rodriguez: None. V.H.Jonas: None. L.D.Pappalardo: None. R.Fang: None. C.Schechter: None. E.A.Walker: None. C.J.Hoogendoorn: None. J.S.Gonzalez: Consultant; Virta Health Corp. Funding National Institute of Health's National Institute of Diabetes Digestive and Kidney Diseases (1R18DK098742-01A1)
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.