# Associations Between Suboptimal Social Determinants of Health and Diabetes Distress in Low-Income Patients on Medicaid

## TL;DR

This study finds that low-income Medicaid patients with diabetes who face social challenges like food insecurity are more likely to experience diabetes distress.

## Contribution

The study identifies a novel association between multiple suboptimal social determinants of health and diabetes distress in a Medicaid population.

## Key findings

- Food-insecure participants had 2.2 times higher odds of diabetes distress.
- Each additional suboptimal social determinant increased diabetes distress odds by 1.5 times.
- 32% of participants reported food insecurity, and most had at least two suboptimal social determinants.

## Abstract

To determine associations between suboptimal social determinants of health (SDoH) and diabetes distress in adults with diabetes on Medicaid.

We surveyed adults with type 2 diabetes covered by Alabama Medicaid. Diabetes distress was assessed using the Diabetes Distress Scale. Suboptimal SDoH included food or housing insecurity; having < high school degree; being unemployed; and household income < $10,000/year. Unadjusted associations between individual SDoH and diabetes distress were examined using logistic regression. We also examined the association between the number of suboptimal SDoH and distress. Multivariable models controlled for age, sex, race, marital status, rurality, diabetes duration, social support, and insulin use.

In total, 433 patients participated (mean age, 50 years (SD 10.4); 80% female; 62% Black). Roughly 32% reported food insecurity, participants experienced a mean of 2 (SD, 0.9; range 0–5) suboptimal SDoH. There was increased odds of diabetes distress in participants who reported food insecurity (OR, 2.2; 95% CI, 1.36–3.65 and OR, 2.35; 95% CI, 1.40–3.93). For each additional suboptimal SDoH a patient experienced, they had increased odds of experiencing diabetes distress (OR, 1.50; CI, 1.15–2.01).

Participants with diabetes who reported food insecurity or experienced a higher number of suboptimal social determinants of health had an increased likelihood of experiencing diabetes distress.