Social Determinants of Health, Goals and Outcomes in High-Risk Children With Type 1 Diabetes

Despite advances in technology and type 1 diabetes (T1D) care, children from low-income families continue to have suboptimal outcomes and increased health-care utilization. In this study, we describe social determinants of health (SDOH) in high-risk children with T1D, as well as their SDOH-related priority goals, and assess the correlation between SDOH, glycemic control and health-care utilization. Caregivers of children aged 4 to 18 years with a diagnosis of T1D of >1 year, poor glycemic control (glycated hemoglobin [A1C] ≥9.5%) or high health-care utilization (≥2 diabetes-related hospitalizations, emergency department attendances or missed outpatient appointments in the previous year) were included. Primary caregiver health-related quality of life (HRQOL), self-efficacy (Maternal Self-Efficacy in Diabetes [MSED] scale) and SDOH were assessed. Goals were identified after assessment by a community health worker. Fifty-three families were included, most (n=48, 91%) of whom had government insurance. Children had a median age of 13.4 (interquartile range [IQR], 12 to 15.3) years and a median A1C of 11.1% (IQR, 10% to 13%). Almost half of the families (n=24, 45%) reported at least 1 adverse SDOH. One or more adverse SDOH was associated with significantly lower total HRQOL scores (56.6 [IQR, 38.5 to 70.7] vs 77.8 [IQR, 60.8 to 92.4], p=0.004), but not associated with A1C (p=0.3), emergency department visits (p=0.9) or MSED (p=0.5). Screening for adverse SDOH and addressing these barriers to glycemic control is not part of routine T1D care. In children with poorly controlled T1D and high health-care utilization, we have demonstrated a high prevalence of adverse SDOH, which may represent a modifiable factor to improve outcomes in this patient population. En dépit des avancées en matière de technologie et de soins du diabète de type 1 (DT1), les enfants des familles à faible revenu ont encore une évolution sous-optimale de leur état de santé et un recours accru aux soins de santé. Dans la présente étude, nous avons décrit les déterminants sociaux de la santé (DSS) des enfants atteints du DT1 exposés à un risque élevé, ainsi que leurs objectifs prioritaires liés aux DSS, et évalué la corrélation entre les DSS, la régulation de la glycémie et le recours aux soins de santé. Nous avons sélectionné les soignants des enfants âgés de 4 à 18 ans qui avaient un diagnostic de DT1 depuis > 1 an, une mauvaise régulation de la glycémie (hémoglobine glyquée [A1c] ≥ 9,5 %) ou un