The American Diabetes Association (ADA) conducted a scientific review of previous research and literature on the association of social determinants of health (SDoH) and diabetes risk and outcomes as well as the impact of targeted interventions.

Diabetes has had a disproportionate impact on ethnic minority and low-income adults in the United States for years. To better understand the impact of SDoH on individuals with diabetes and advance opportunities for improvement, the ADA convened a writing committee prior to the COVID-19 pandemic to perform a scientific review, which was published this week.

“People living with diabetes face many challenges. Some of these relate to the disease itself, but increasingly we recognize the importance of many social determinants,” said Robert A. Gabbay, chief scientific and medical officer for the ADA, in an announcement. “The scientific review not only defines these issues but shines a bright light on the resulting health disparities and articulates an important research agenda to address these issues.”

For its review, the writing committee referenced works from the World Health Organization, Commission on Social Determinants of Health, Health People 2020, the County Health Rankings Model, and Kaiser Family Foundation Social Determinants of Health factors.

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The committee also reviewed studies conducted in the U.S. on adults with diabetes, and focused on five SDoH and component factors:

  1. Socioeconomic status (education, income, and occupation)
  2. Neighborhood and physical environment (housing, built environment, and toxic environmental exposures)
  3. Food environment (food security, food access, and food availability)
  4. Health care (access, affordability, and quality)
  5. Social context (social cohesion, social capital, and social support)

Through their review, the writing committee did find SDoH evidence supporting associations of these SDoH with diabetes-related outcomes. “Inequities in living and working conditions and the environments in which people reside have a direct impact on biological and behavioral outcomes associated with diabetes prevention and control,” wrote the ADA committee in the scientific review.

Based on the review, the committee established the following recommendations for SDoH and diabetes research:

  • Establish consensus SDoH definitions and metrics
  • Design studies to examine specificities in SDoH and impacts among populations with diabetes
  • Prioritize next-generation interventions that target SDoH as the root cause of diabetes inequities
  • Embed SDoH considerations within diabetes research and evaluation studies
  • Train researchers in methodologies and techniques for future SDoH intervention studies

“By addressing these critical elements, there is potential for progress to be realized in achieving greater health equity in diabetes and across health outcomes that are socially determined,” the committee wrote in the review.