Social Determinants of Health Are Linked With Adolescent Prediabetes

June 12, 2024

Food insecurity, low household income and not having private health insurance are associated with higher rates of prediabetes in adolescents, independent of race and ethnicity, according to a new JAMA Network Open study by University of Pittsburgh and UPMC researchers.

The findings suggest that screening for social determinants of health—the nonmedical factors that influence a person’s health and risk of disease—may help identify youths at risk of prediabetes, which could improve early interventions that prevent progression to type 2 diabetes.

“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,” said senior author Mary Ellen Vajravelu, assistant professor of pediatrics, School of Medicine, of epidemiology, School of Public Health, and pediatric endocrinologist at UPMC Children’s Hospital of Pittsburgh. “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.” 

Prediabetes is defined by higher-than-normal blood sugar, which can progress to type 2 diabetes if not addressed with lifestyle changes such as diet and exercise.  

According to Vajravelu, type 2 diabetes and prediabetes are more prevalent among youths who identify as Native American, Alaska Native, Asian, Black and Hispanic than their white counterparts. However, because these minoritized groups are also more likely to experience adverse social determinants of health, it is likely that these social factors, rather than race itself, influence disease risk.  

“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,” said Vajravelu. “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 researchers used data from the National Health and Nutrition Examination Survey to identify 1,563 participants 12 to 18 years old with obesity, 8.5% of whom had elevated blood glucose, or hemoglobin A1c, indicating prediabetes. Then they looked at three social determinants of health related to diabetes management: food security, health insurance and household income.

Adverse scores for all three were linked with prediabetes risk. Prevalence of prediabetes was 4.1% higher among participants from households with food insecurity compared to those with food security, 5.3% higher in youths with public compared to private insurance, and 5.7% higher in youths with household income at less than 130% of the federal poverty level compared to those with higher incomes.

Adverse social determinants of health could influence diabetes risk in several ways. For example, families experiencing food insecurity are less likely to have access to healthy foods to prevent diabetes, and those without private insurance may have more limited access to health care.

More information is available in the news release and in the study.