The social determinants of glycaemic control in type 2 diabetes mellitus

Abstract

The social determinants of health are important contributors to health inequalities and have prognostic significance for biomedical profiles, morbidity and mortality. Despite this, in type 2 diabetes, there is a focus on the traditional medical model of care with little emphasis on the social contexts within which individuals are embedded. The primary aim of this thesis was to identify the social determinants of glycaemic control over 2 years in individuals with newly diagnosed (< 6 months duration) type 2 diabetes. A prospective cohort was used. Individuals with newly diagnosed type 2 diabetes were recruited from primary care centres in 3 adjacent boroughs of South East London. The setting was multi-ethnic and socio-economically diverse. Socio-demographic, biomedical, psychological and social data were collected using standardised data collection schedules, clinical assessments and from medical records. The main outcome was HbA1c (mmol/mol) at 2 years. Mixed effects multi-level models were used to investigate associations between social variables and HbA1c when accounting for relevant confounding and clustering within general practices. From 96 general practices, 1447 participants were recruited between September 2008 and November 2011. Their mean age was 56 years (±11.06), 55% were male and 51%, 38% and 11% of the sample were white, black and south Asian/other ethnicities respectively. In multi-level models neither social support nor the neighbourhood environment were significantly associated with HbA1c at 2 years after correcting for multiple testing. Type 2 diabetes is a major and growing burden to the individual and to society. Current models of social mechanisms for ill health do not appear to apply to people at the time they are diagnosed with type 2 diabetes, but this does not mean they are not important. These findings may suggest that social processes in the natural history of type 2 diabetes are more complex than originally presumed. They highlight the need to revisit and potentially, re-define the conceptual underpinnings of social theories to be applicable to type 2 diabetes.

Date of Award	2018
Original language	English
Awarding Institution	King's College London