The Role of Social Determinants of Health and Diabetes Self-Management on Glycemic Indices: A Cross-Sectional Analysis

Background/Objectives: Type 2 diabetes (T2D) is a substantial health burden on foreign-born Haitian Americans (FBHAs) in the United States, who experience poorer health outcomes for T2D, in particular, cardiovascular disease and diabetes nephropathy. Understanding the factors that contribute to these disparities is essential. The purpose of this study was to examine the association between demographic, clinical, diabetes self-management, and social determinants of health (SDoH) factors with continuous glucose monitor (CGM-derived) glycemic indices in adult FBHAs with T2D. Methods: A cross-sectional exploratory correlation study was conducted in two urban health clinics, focusing on FBHAs aged 21 or older who had T2D for at least one year. Data were analyzed using SAS 6.4, employing descriptive statistics, bivariate correlations, and multiple regression models. Results: The study included 59 participants (49.2% male; mean age = 51.7 years, SD = 9.9), with an average T2D duration of 7.7 years (SD = 6.8) and an average of 1.63 (SD = 1.30) chronic diseases. A total of 29% were overweight while 21% had obesity with a mean HbA1c of 58 mmol/mol (7.5%). A higher body weight and poorer dietary habits were associated with elevated glucose levels (standardized β ≈ 0.25 and −0.24). Greater race-related stress was correlated with greater glucose variability (β ≈ 0.46). Conclusions: These findings highlight the importance of addressing SDoH, such as race-related stress and food insecurity, to improve T2D self-management among FBHAs. Assessing and mitigating these risk factors can enhance glycemic control and health outcomes. Additionally, the findings demonstrate that CGM is feasible and acceptable for this population, showing exploratory findings and preliminary effect sizes that provide a strong basis for future, large-scale investigations.

Duke Scholars

Author Bei Wu School of Nursing