Prediabetes linked to social determinants of health, not race

A group of researchers from the University of Pittsburgh and UPMC have identified a link between social determinants of health and youth-onset diabetes.

Specifically, social determinants of health (SDOH) such as food insecurity, low household income and not having private insurance are linked to prediabetes in adolescents, the researchers wrote in JAMA Network Open.

These findings are promising because they indicate a path forward for chronic disease prevention, according to Mary Ellen Vajravelu, the study's senior author, assistant professor of pediatrics at Pitt and pediatric endocrinologist a UPMC Children's Hospital of Pittsburgh.

"This study underscores the importance of using social factors, which are modifiable -- meaning that we can address them -- to understand and reduce diabetes risk in adolescents as opposed to personal, nonmodifiable characteristics like race and ethnicity," Vajravelu said in a statement.

Indeed, youth-onset prediabetes has become increasingly common, with 28% of all U.S. adolescents and 40% of adolescents with obesity presenting with prediabetes. Prediabetes, plus type 2 diabetes, can be extremely serious when they start in childhood and adolescence, Vajravelu and colleagues wrote in the study.

However, prediabetes affects certain populations more than others. Kids who identify as Native American, Alaska Native, Asian, Black and Hispanic are all more likely to have prediabetes or type 2 diabetes than their white counterparts.

This latest study contends that it's the disproportionate SDOH burden these populations carry, not their race itself, that leads to higher occurrence of prediabetes and type 2 diabetes.

The researchers assessed a group of 1,563 teens ages 12 to 18 with obesity, 8.5% of whom had high hemoglobin A1c, which can indicate prediabetes. The team then looked at the occurrence of three common SDOH, including food security, health insurance status and household income.

All three of those SDOH were linked to heightened prediabetes risk. Prediabetes was 4.1% more common among kids from households with food insecurity and 5.3% higher among teens with public versus private insurance. Additionally, prediabetes was 5.7% higher for kids from low-income households (defined as a household income less than 130% of the federal poverty level).

Key findings emerged when breaking data down by race/ethnicity. For white teens, experiencing more SDOH was linked with a higher risk for prediabetes compared to their peers of other races/ethnicities. Specifically, white kids experiencing two or more SDOH were four times more likely to have prediabetes than white kids facing only one SDOH.

In other words, SDOH is a better predictor of prediabetes risk than race or ethnicity, the researchers indicated.

"If we use race and ethnicity to guide us in identifying children at risk of prediabetes, it could steer us away from screening children who do not fall into a higher risk race or ethnicity category," Vajravelu stated. "Instead, if we tailor our screenings based on exposure to risk factors, not race, we might be able to pick up additional children who are at risk for diabetes."

The healthcare industry seems to be moving in that direction, Vajravelu added.

"Many medical guidelines are moving away from the use of race and ethnicity to determine care and screening practices because it can exacerbate disparities instead of reducing them," she said.

Still, it will be helpful to assess how certain SDOH affect specific disease states moving forward. In the case of prediabetes, the researchers pointed out that low income could lead to food insecurity or lack of access to nutrient-dense foods.

Meanwhile, limited access to health payer coverage, or access to public payer coverage, could limit healthcare access across the board, leading to missed opportunities for patient engagement and health coaching.

Sara Heath has been covering news related to patient engagement and health equity since 2015.