title: Social determinants of health in adults with type 2 diabetes--Contribution of mutable and immutable factors.
abstract: OBJECTIVE
  Socioeconomic, psychosocial, and neighborhood factors influence clinical outcomes and self-care behaviors in diabetes; however, few studies simultaneously assessed the impact of multiple social determinant of health factors on glycemic control. We used an explanatory model to examine the differential contribution of social determinants and clinical factors on glycemic control. Secondarily, we examined the contribution of mutable and immutable factors to identify meaningful future interventions.
  
  
  METHODS
  Six hundred and fifteen adults with type 2 diabetes in the southeastern United States were recruited. A hierarchical model was run with HbA1c as the dependent variable and independent variables entered in blocks: demographics (block 1), socioeconomic (block 2), psychosocial (block 3), built environment (block 4), clinical (block 5), and knowledge/self-care (block 6).
  
  
  RESULTS
  Significant associations for HbA1c included self-efficacy (β=-0.10, p<0.001), social support (β=0.01, p<0.05), comorbidity (β=-0.09, p<0.05), insulin use (β=0.95, p<0.001), medication adherence (β=-0.11, p<0.05), and being a former smoker (β=0.34, p<0.05); accounting for 24.4% of the variance.
  
  
  CONCLUSIONS
  Important factors that drive glycemic control are mutable, and amenable to health interventions. Greater attention should be given to interventions that increase self-efficacy and social support, reduce the burden of comorbidities, and enhance medication adherence and smoking cessation.
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Brittany L
authors.initials: BL
authors.lastname: Smalls
authors.affiliation: Health Equity and Rural Outreach Innovation Center (HEROIC), Charleston VA HSR&D COIN, Ralph H. Johnson VAMC, Charleston, SC, USA; Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA; Division of General Internal Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Electronic address: egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000328:Adult; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D012307:Risk Factors; D012648:Self Care / Q000523:psychology*; D020377:Self Efficacy; D064890:Social Determinants of Health; D012944:Social Support; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Built environment; Diabetes; Psychological; Social determinants; Socioeconomic