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

Emily H Williams; Lucia D Juarez; Caroline A Presley; April Agne; Andrea L Cherrington; Carrie R Howell

doi:10.1007/s11606-025-09367-z

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

J Gen Intern Med. 2025 Mar 3. doi: 10.1007/s11606-025-09367-z. Online ahead of print.

Authors

Emily H Williams¹, Lucia D Juarez², Caroline A Presley², April Agne², Andrea L Cherrington², Carrie R Howell²

Affiliations

¹ Tinsley Harrison Internal Medicine Residency Training Program, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1808 7th Avenue South, Birmingham, AL, 35233, USA. emilyharrison@uabmc.edu.
² Division of Preventive Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1717 11Th Avenue South, Birmingham, AL, 35205, USA.

PMID: 40029547
DOI: 10.1007/s11606-025-09367-z

Abstract

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

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: diabetes; diabetes distress; low SES; social determinants of health.

Abstract

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