P3.171: Social Determinants of Health and Pediatric Diabetes Outcomes: The Importance of Screening

Background: Social determinants of health (SDOH), such as access to food, housing stability, employment, and healthcare resources, significantly influence diabetes management outcomes in pediatric populations. Research indicates children from lower socioeconomic backgrounds often experience poorer glycemic control, higher rates of diabetic ketoacidosis, and increased hospital admissions. Despite International Society for Pediatric and Adolescent Diabetes guidelines recommending annual screening for SDOH, UF Health Pediatrics Diabetes Clinic currently limits screening to initial patient visits.

Methods: This study evaluated the prevalence and impact of unmet SDOH needs on hemoglobin A1c (HbA1c) levels among pediatric diabetes patients at UF Health Pediatrics Diabetes Clinic. Participants included parents/caregivers or patients aged 18 years or older, recruited during routine outpatient clinic visits. Electronic consent was secured via REDCap, a reputable survey software. Participants completed a survey designed to identify unmet SDOH needs across domains such as housing, employment, food insecurity, education, financial stability, transportation, and healthcare access. Clinical outcomes, specifically HbA1c levels, were extracted from electronic health records. On the day the survey was completed, participants received a resource flyer related to the need(s) they identified. Statistical analyses included descriptive statistics and inferential analyses to examine associations between unmet SDOH needs and glycemic control.

Results: Among the 187 participants, 58.6% reported having at least one unmet SDOH need, with employment being the most frequently indicated. Housing instability was identified as the only statistically significant predictor of increased HbA1c levels, associated with an average HbA1c elevation of approximately 1.95%. Although homelessness risk was highly correlated with multiple additional SDOH needs, it did not independently predict elevated HbA1c. Transportation difficulties also approached statistical significance (p = .07), suggesting potential implications for glycemic control.

Conclusion: Housing instability notably interferes with pediatric diabetes management, underscoring its pivotal role among various social determinants. Housing insecurity frequently coexists with chronic stress and limited healthcare access which would further impair glycemic control. While homelessness risk correlated strongly with housing concerns, it did not independently predict HbA1c, suggesting that perceived difficulties in diabetes management, rather than imminent housing loss, primarily drive poor glycemic outcomes.The findings emphasize the critical need for systematic and comprehensive SDOH screening protocols, along with targeted, supportive interventions. Further investigation into the trend toward higher HbA1c associated with nearly all unmet SDOH needs is warranted. Expanding data collection may identify additional significant associations, thus better informing clinical practice and resource allocation to enhance diabetes care outcomes among vulnerable pediatric populations.