Are social determinants of health associated with the development of early complications among young adults with type 2 diabetes? A population based study using linked databases

• Published in: Primary care diabetes 2023-04, Vol.17 (2), p.168-174
• Main Authors: Nieuwenhuijse, Emma A., van Hof, Teske B., Numans, Mattijs.E., Struijs, Jeroen N., Vos, Rimke C.
• Format: Article
• Language: English
• Subjects: Adult; Diabetes Complications; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Female; Glycated Hemoglobin; Humans; Hypoglycemic Agents; Male; Routine care data; Social Determinants of Health; Type 2 diabetes; Young Adult; Young adults
• ISSN: 1751-9918; 1878-0210
• DOI: 10.1016/j.pcd.2023.01.002

To quantify the impact of social determinants of health (SDOH) on top of medical determinants on the development of diabetes-related complications in young adults with type 2 diabetes. In this observational population-based study, SDOH (income and origin) were linked to routine primary care data. Young adults (18–45 years) with incident type 2 diabetes between 2007 and 2013 were included. The main outcome, the development of the first micro- or macrovascular complication, was analyzed by multivariate Cox regression. Medical determinants included antidiabetic treatment, HbA1c in the year after diagnosis, body mass index, comorbidity and smoking. Of 761 young adults (median age: 39 years (IQR 33–42), men: 49%, Western origin: 36%, low income: 48%), 154 developed at least one complication (median follow-up 99 months (IQR 73–123)). Young men of non-Western origin were more likely to develop a complication (HR 1.98 (1.19–3.30)), as were young adults with HbA1c > 7% (>53 mmol/mol) (HR: 1.72 95% CI: 1.15–2.57). No associations were found with income. Being women was protective. In this multi-ethnic population, non-Western origin was associated with the development of complications, but only in men. Low income was not associated with developing complications. The importance of adequate HbA1c regulation was re-emphasized by this study. •Social disadvantage may be present in diabetes complications in young adults.•Young men with non-Western origin were more likely to develop a complication.•Income was not associated with diabetes complication development.•Young adults with uncontrolled HbA1c were more likely to develop a complication.•Proactive treatment should focus on HbA1c regulation in all at-risk populations.