511-P: Treatment Burden, Glycemic Control, and Social Determinants of Health in Patients with Type 2 Diabetes

Abstract

Burden of treatment (BoT) is the work of self-management of chronic conditions and its impact on function and well-being. BoT may negatively affect behavioral outcomes. With 90% of patients with type 2 diabetes (T2DM) having at least 1 comorbid condition, BoT may be important to consider, especially among populations experiencing disparities. However, links between BoT and clinical outcomes are unclear. Using a cross-sectional survey and electronic health record data, we sought to determine associations between BoT (using a validated measure) and glycemic control (A1c) among low-income patients with T2DM in 6 safety net primary care clinics, and whether BoT and A1c were related to medication adherence and social determinants of health (SDOH). We used descriptive statistics and correlations, then ANOVA to compare 4 groups by high vs. low A1c (cut at 7%) and BoT (cut at median). Of 192 respondents, average age was 55 with 63% female and 64% non-white; 23% had low health literacy, 26% worried about housing, 35% reported medical-related financial difficulties, and 17% did not always have enough food. Average A1c was 7.6%. While there was no association between A1c and BoT (rho=0.01, p=0.86), both were independently associated with health literacy, perceived self-management self-efficacy, and diabetes-related distress (rho range 0.15-0.65, p=<0.001-0.04). A1c was not associated with medication adherence, but BoT was (rho=0.24, p=0.001). Housing worry, financial difficulties, and food insecurity were higher, and adherence lower, in the High A1c - High BoT group than in the Low A1c - Low BoT group (p=0.006-0.01). For the High A1c - Low BoT and Low A1c - High BoT groups, BoT was more important than A1c for these associations. The relationships between BoT and A1c are complex, but SDOH and adherence may be important mediators. These may be appropriate intervention targets for glycemic control, particularly among low-income and minority patients. Determining causality requires further study. Disclosure E. A. Rogers: None. S. T. Manser: None. S. Arriaza: None. M. Linzer: Other Relationship; Self; American College of Physicians, CRICO Malpractice and Harvard University, Research Support; Self; Agency for Healthcare Research and Quality, American Board of Internal Medicine, American Medical Association, Institute for Healthcare Improvement, National Heart, Lung, and Blood Institute, National Institute for Nursing Research. Funding National Institutes of Health (K23DK118207)