Publication Date

5-2024

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Abstract

Objective: Screening for health-related social needs (HRSNs) is recommended as part of routine diabetes care given the strong impact of social factors on health outcomes. Our objective was to compare diabetes-related health outcomes among youth presenting to a tertiary diabetes center based on whether they screened positive or negative for HRSNs at a routine clinic visit. Methods: Baseline data were collected from patients whose parent/guardian completed a HRSN screen as part of their child’s diabetes clinic intake from 9/1/21 to 8/30/22. The screen is a 6-item questionnaire adapted from the Accountable Health Communities HRSNs Screening Tool. Longitudinal data were analyzed from the time of first screen through 8/30/23. Comparisons were made using chi-square or t-test. Results: Among 1880 unique respondents, 14% were positive for at least one HRSN. The most common HRSN was food insecurity (72%). A positive HRSN screen was more likely in non-white minorities (22% vs. 11% non-Hispanic white youth), publicly insured (22% vs. 8% privately insured), youth with a type 2 diabetes diagnosis (32% vs. 12% with type 1 diabetes), all p<0.001. Those with a positive vs. negative HRSN screen at baseline were more likely to have any A1c > 10% (32% vs. 19%), any A1c >13% (9% vs. 4%), at least one no-showed appointment (41% vs. 26%), a positive PHQ4 screen for anxiety/depression (22% vs. 11%), and a second positive HRSN screen (29% vs. 5%), all p<0.001, during the follow up period (mean 14.8 =/- 2.0 months). They were more likely to have an ED visit (17% vs. 12%, p 0.025), though DKA admissions were not significantly different between the groups (6% vs. 4%, p=0.15). Insulin pumps (58% vs. 75%) and continuous glucose monitors (CGMs) (58% vs. 76%) were also less utilized throughout the study period in those screening positive for a HRSN at baseline, p<0.001. Conclusion: Youth with positive HRSN screenings during diabetes clinic appointments experience suboptimal diabetes-related outcomes, including higher A1c levels, increased rates of missed appointments, anxiety/depression, ED visits, and less utilization of diabetes technologies. This highlights the importance of addressing social risk factors when treating youth with diabetes to enhance equity in delivery of care and improve health outcomes.

Disciplines

Endocrinology, Diabetes, and Metabolism | Pediatrics

Notes

Presented at the Pediatric Endocrine Society (PES) 2024 Annual Meeting; Chicago, IL; May 2-5, 2024.

The Impact of Health-Related Social Needs on Health Outcomes among Youth Presenting to a Midwest Pediatric Diabetes Clinic Network

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