Role of social and other determinants of health in the effect of a multicomponent integrated care strategy on type 2 diabetes mellitus

• Published in: International journal for equity in health 2020-05, Vol.19 (1), p.75-75, Article 75
• Main Authors: Silva-Tinoco, Rubén, Cuatecontzi-Xochitiotzi, Teresa, De la Torre-Saldaña, Viridiana, León-García, Enrique, Serna-Alvarado, Javier, Guzmán-Olvera, Eileen, Cabrera, Dolores, Gay, Juan G, Prada, Diddier
• Format: Article
• Language: English
• Subjects: Activities of daily living; Blood cholesterol; Blood pressure; Body mass index; Case management; Cholesterol; Cholesterol tests; Complications; Design; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes therapy; Diet; Education; Effect; Empowerment; Glucose; Glycosylated hemoglobin; Health aspects; Health care; Health care policy; Health education; Hemoglobin; Interdisciplinary aspects; Intervention; Knowledge; Levels; Literacy; Low density lipoprotein; Low density lipoproteins; Metabolism; Multicomponent integrated care strategy; Objectives; Primary care; Quality of life; Social determinants of health; Socioeconomic factors; Socioeconomic status; Socioeconomics; Type 2 diabetes; Type 2 diabetes mellitus
• ISSN: 1475-9276; 1475-9276
• DOI: 10.1186/s12939-020-01188-2

Although important advances in treatment strategies have been developed in type 2 diabetes mellitus (T2DM), large gaps exist in achieving glycemic control and preventing complications, particularly in low-and middle-income countries, which suggests a potential effect of social determinants of health (SDH, i.e., education level and socioeconomic status). However, few studies have determined the role of SDH and other determinants of health (ODH, i.e., diabetes knowledge and self-care scores) in achieving T2DM goals during effective multidisciplinary interventions. We aimed to examine a multicomponent integrated care (MIC) program on diabetes care goals and determine the effect of SDH and ODH on T2DM patients. A before-and-after design (a pretest, a 5-month intervention, and a follow-up) was used in a T2DM population from Mexico City. The SDH included education level and socioeconomic status; the ODH included diabetes knowledge, self-care scores, and deltas (i.e., differences between baseline and follow-up scores). The triple-target goal (glycated hemoglobin, blood pressure, and LDL-cholesterol) was established as a measurement of T2DM goals. The DIABEMPIC (DIABetes EMPowerment and Improvement of Care) intervention (n = 498) reduced the glycated hemoglobin levels (mean reduction 2.65%, standard deviation [SD]: 2.02%) and cardiometabolic parameters; it also improved health-related quality of life. From 1.81% at baseline, 25.9% of participants (p-value