65-LB: Social Determinants of Health Predict Self-Care in Type 1 Diabetes

Abstract

Social determinants of health (SDH), or the conditions in which people live, learn, work, play, and age strongly influence health inequities among adults with type 1 diabetes (T1D). Diabetes self-care, or daily behaviors performed to maintain health (maintenance), monitor for changes (monitoring), and manage illness (management), is essential for T1D management, but may also be impacted by SDH. We aimed to determine if SDH predicted self-care maintenance, monitoring and management, and if so, identify which SDH items were the most salient predictors. A diverse sample of adults with T1D (n=200, 27% Black, 61% female, median age: 35 years, disease duration: 19 years) completed an SDH risk assessment (PRAPARE tool; Risk Tally Scoring Method applied to 14 items to yield a composite risk score) and self-care assessment (Self-Care of Diabetes Inventory [SCODI]; 3 self-care [maintenance, monitoring, and management] and 1 confidence scale). A multivariable linear regression model of each self-care scale was built with SDH risk and confidence as predictors of self-care. For each self-care scale exhibiting a significant association with SDH risk, an exploratory multivariable model was built to determine which of the 14 SDH items were the most salient predictors. SDH risk was a significant predictor of self-care maintenance. For every 1 unit increase in SDH risk, maintenance was estimated to decrease by 1.14 units (p< .01). Exploratory multivariable analysis revealed employment insecurity and material insecurity to be the most salient SDH risk predictors of maintenance. Participants who were not employed full-time were estimated to have maintenance scores 5.15 ± 2.27 units (p<.05) less. For every 1 unit increase in material insecurity (score range:0 - 7), estimated maintenance decreased by 2.6 ± .89 units (p < .01). Those with higher SDH risks are less likely to perform behaviors to maintain health. Providers may facilitate self-care of patients by assessing SDH risks and offering self-care guidance considerate of SDH risks. Disclosure A. M. Matus: None. B. Riegel: None. M. R. Rickels: Consultant; Sernova, Corp., Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Dompé. Funding National Institutes of Health (31NR020137, R01DK091331)