1108-P: Care Cascade Engagement and Characteristics of Diabetes Awareness in Adult Samoans in 2010 and 2018

Abstract

We describe diabetes care cascade engagement in 2010 and 2018 in adult Samoans and identify the characteristics of diabetes awareness. Participants were from a 2010 study of Samoans (n=2980, 24.5-< 65 years old), n= 500 of whom were followed-up in 2018 (32.5-72.5 years old). At follow-up individuals with a genetic variant associated with lower fasting glucose were oversampled by design. Care cascade components included diabetes prevalence (fasting glucose ≥ 126 mg/dL or diabetes medication use), self-report of doctor’s diagnosis of diabetes (awareness), diabetes medication use, and meets recommended glycemic control (fasting glucose ≤ 130 mg/dL). Percentage loss (proportion of individuals lost from each preceding stage) and unmet need of care (total prevalence - proportion of participants with controlled diabetes) were estimated. Characteristics associated with awareness were examined with logistic regression. In 2010, 469/2980 (15.7%) participants had diabetes, 242 (48.4% loss) were aware, 215 (11.1% loss) reported medication use, and 33 (84.6% loss) met glycemic control (unmet need of 92.9%). In 2018, 146 (29.2%) had diabetes; 61 (57.8% loss) were aware; 48 reported medication use (22.6% loss), and 7 (85.4% loss) met glycemic control (unmet need of 95.2%). Each year of added age (OR 1.07 [1.04-1.10] in 2010 and OR 1.06 [1.01-1.11] in 2018), and higher material lifestyle scores, a proxy for socioeconomic position, (OR 1.16 [1.02-1.33] in 2018) were associated with higher odds of diabetes awareness, and higher BMI (OR 0.93 [0.90-0.96] in 2018) and OR 0.94 [0.89-0.99] in 2018) and smoking (OR 0.49 [0.31-0.78] in 2010) with lower odds of awareness. We observed a very high level of unmet need in diabetes care and a high proportion of participants lost within the care cascade at both time points. Greater odds of disease awareness with increasing socioeconomic position in 2018 suggest that socioeconomic constraints may limit care engagement. Disclosure A. C. Rivara: None. N. Hawley: None. E. M. Russell: None. S. Viali: None. M. Reupena: None. T. K. Naseri: None. A. Pomer: None. R. L. Minster: None. D. E. Weeks: None. S. T. Mcgarvey: None. Funding National Institutes of Health (R01HL093093, R01HL140570, R01HL133040)