Targeting social needs may help improve type 2 diabetes outcomes, review finds

Interventions with targeted, multicomponent designs that combine medical and nonmedical approaches can reduce risk for and improve clinical outcomes of type 2 diabetes, according to a systematic review.

The review looked at 10 studies of nonmedical interventions for type 2 diabetes that targeted social drivers of health. The included studies measured an intervention effect using a clinical trial, quasi-experimental, or pre-post design; included a population of adults at risk for or with type 2 diabetes; and had HbA1c levels, blood pressure, lipids, self-care, or quality of life as outcomes. Results of the review were published by Health Affairs on June 27.

Three of the 10 studies focused on food insecurity, three focused on financial incentives, two focused on integrating medical care with nonmedical care, one focused on the built environment, and one focused on housing. Structural racism was included as a search term but resulted in no studies. Eight of the studies were randomized clinical trials, and two used pre-post study designs. Sample sizes ranged from 35 to 4,498 people. Nine studies examined the treatment of type 2 diabetes, and one study examined prevention.

The review found that HbA1c levels improved significantly when programs provided food supplementation with referral and diabetes support, financial incentives with education and skills training, housing relocation with counseling support, and the integration of nonmedical interventions into medical care using the electronic medical record. The researchers observed that more work is needed to develop and test multicomponent interventions that address the social and medical needs of adults with type 2 diabetes, particularly among populations that experience health inequity. They said that targeting social risk factors with medical interventions could reduce and prevent the burden of diagnosed type 2 diabetes, noting that HbA1c levels improved significantly with nonmedical interventions alone and with medical interventions combined with nonmedical interventions. They called for multilevel interventions to address structural racism by targeting system and environmental inequities, which includes addressing chronic, individual stress.

Policy-based actions that could target elevated social risk and health disparities include expanding Medicaid, ameliorating vulnerabilities of the health system created by COVID-19, broadening existing coverage of the No Surprises Act, making labor market changes to the minimum wage and paid time off, and expanding Department of Housing and Urban Development programs.

“Our findings demonstrate that the literature on nonmedical interventions designed to address relevant social factors and target structural racism is limited,” the review stated. “The article offers actionable strategies and identifies policy opportunities for targeting structural inequalities and decreasing social risk among adults with type 2 diabetes.”