SUN-553 - Health-Related Social Needs and Diabetes Awareness, Treatment, and Control in U.S. Adults: NHANES Survey-Weighted Analysis

Unmet health-related social needs (HRSNs) may impede diabetes diagnosis, treatment, and control, yet national evidence across the diabetes care cascade is limited. We evaluated associations between unmet HRSNs and diabetes awareness, treatment, and control among a nationally representative sample of U.S. adults.

We conducted a cross-sectional analysis of adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (2007–2018) with data on hemoglobin A1c (HbA1c), self-reported diabetes diagnosis, antidiabetic medication use, and social needs measures. Diabetes was defined as HbA1c ≥ 6.5%, antidiabetic medication use, or self-reported diagnosis. Outcomes were awareness (self-reported diagnosis), treatment (antidiabetic medication use), and control among those treated (HbA1c < 7%). We identified 6 HRSN components: housing instability, food insecurity, financial strain, employment need, uninsured, and marital status. Each domain was treated as unmet (yes/no); total HRSNs were summed (0–6). Survey-weighted logistic regression models estimated the odds of awareness, treatment, and control by domain and per additional HRSN, adjusting for age and having a primary care physician. Sex differences were explored using stratified models.

Among 28,581 adults (mean age 48; 52% female), 76% had ≥1 unmet HRSN. Population distribution across glycemic/cascade states was: normoglycemic 87%, unaware diabetes 3%, aware–untreated 2%, treated–uncontrolled 4%, treated–controlled 4%. Each additional unmet HRSN was associated with lower odds of treatment among males (OR 0.90). In overall domain-specific models, being uninsured was associated with lower odds of awareness (OR 0.66), treatment (OR 0.40), and control (OR 0.73); financial strain was associated with lower odds of treatment (OR 0.80); food insecurity with lower odds of being in control (OR 0.80); employment need was associated with increased odds of awareness (OR 1.44) and control (OR 1.29); and living alone (not married or partner) was associated with increased odds of being controlled (OR 1.19). Associations differed by sex: financial strain was associated with lower odds of treatment and control among females, and food insecurity was associated with decreased odds of treatment among males.

Unmet health-related social needs were common and were associated with gaps in the diabetes care cascade, particularly lower odds of treatment and glycemic control. Associations varied by domain and sex, with insurance status, food insecurity, and financial strain showing the most consistent links to poorer treatment and control. These findings support integrating systematic assessment of social needs—especially insurance, food, and financial barriers—into diabetes care and targeting resource linkage strategies that may improve treatment uptake and glycemic outcomes.

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