🔎︎
Recent research shows that a community-based program for diabetes self-management and support can improve quality of life (QOL) for patients with varying levels of social vulnerability.
“In the past 25 years, all forms of diabetes have increased in prevalence, making the chronic condition a significant public health challenge in the United States and globally,” wrote the authors, led by Samatha Kanny, PhD, of the Department of Public Health Sciences at Clemson University in South Carolina. “Evidence suggests that higher social vulnerability is related to adverse effects for those living with diabetes, such as increased symptom burden and attrition rates in diabetes management programs.”
Therefore, the researchers set out to examine whether integrating social determinants of health into a diabetes management program could affect QOL outcomes, such as physical and mental well-being.
The analysis was part of a larger longitudinal study of the Health Extension for Diabetes (HED) program. The 4-month, community-based program includes eight biweekly group educational sessions, as well as personalized support between sessions, designed to help participants manage diabetes. The program is based on the Association of Diabetes Cares and Education Specialists’ Seven Self-Care Behaviors for Managing Diabetes: healthy coping, healthy eating, being active, taking medication, monitoring, problem-solving, and reducing risks.
The current analysis included 1,006 patients in the HED. The researchers used the 12-Item Short Form Health Survey (SF-12) to assess the participants’ physical and mental QOL before and after program participation. They also used the CDC’s Social Vulnerability Index (SVI) to determine each individual’s social vulnerability level, considering factors such as poverty, access to healthcare, education level, minority status, and transportation/housing insecurity. A person’s SVI can be low (0-0.25), low to moderate (0.2501-0.5), moderate to high (0.501-0.75), or high (0.7501-1.0).
The researchers focused on changes in SF-12 before and after the HED program, as well as associations between QOL and level of social vulnerability. Overall, program participants experienced significant improvements in physical and mental QOL. Improvements in physical health occurred for patients at all levels of social vulnerability. Mental health scores improved among those with moderate to high and high SVI scores, but not among those with low or low to moderate SVI scores.
The authors noted that it was challenging to encourage adherence to physical activity routines among patients with high social vulnerability. They also indicated that future programs should consider implementing general mental health resources to address the psychologic burden often associated with chronic disease.
