Social Disorder in Adults with Type 2 Diabetes: Building on Race, Place, and Poverty

Abstract

The recent resurgence of social and civic disquiet in the USA has contributed to increasing recognition that social conditions are meaningfully connected to disease and death. As a “lifestyle disease,” control of diabetes requires modifications to daily activities, including healthy dietary practices, regular physical activity, and adherence to treatment regimens. One’s ability to develop the healthy practices necessary to prevent or control type 2 diabetes may be influenced by a context of social disorder, the disruptive social and economic conditions that influence daily activity and, consequently, health status. In this paper, we report on our narrative review of the literature that explores the associations between social disorder and diabetes-related health outcomes within vulnerable communities. We also propose a multilevel ecosocial model for conceptualizing social disorder, specifically focusing on its role in racial disparities and its pathways to mediating diabetes outcomes.

Social Determinants of Poor Management of Type 2 Diabetes Among the Insured

“…Further, individuals who lived continuously in the most advantaged residential areas took less time to achieve glycemic control compared with the individuals who lived continuously in the least advantaged residential areas, and moving from more advantaged residential areas to less advantaged residential areas was related to worsening diabetes control [ 41 ]. In a review on social order in diabetes, Steve et al also conceptualize and demonstrate that signs of physical disorder within the built environment (e.g., dilapidated housing, few recreational spaces, broken glass on the ground) are associated with unhealthy behaviors (e.g., physical inactivity, poor dietary habits) and poor health outcomes (e.g., poor diabetes control) [ 43 ]. More studies are needed to assess the association between elements of physical disorder and diabetes control.…”

Geographic Information Systems to Assess External Validity in Randomized Trials

“…This approach capitalizes on geographic location as a principal variable, 18 which reflects variation in a wide range of place-based characteristics associated with health. 19,20 This information may include but is not limited to age, 30 education, 43 income, 29,43 racial segregation, 14,44 employment, 45 household composition, 14,43 healthcare access, 14,31 comorbidities, 46,47 availability of recreational facilities, 19,29 and quality of food sources. 15,19 Geographic location reflects multivariate effects of unequal distribution of resource and its influences on physical and social environments.…”

“…The “principal variable” characteristics 18 of geographic location serve as a proxy for a wide range of measures known to be highly correlated to where a person lives. 19,20 Type 2 diabetes mellitus is a chronic disease that is not uniformly distributed across geographic areas. 21 Higher prevalence of Type 2 diabetes is generally found in underserved populations, that is, those living in communities with few health-promoting resources and less access to care.…”

“…21 Higher prevalence of Type 2 diabetes is generally found in underserved populations, that is, those living in communities with few health-promoting resources and less access to care. 20,22–24 …”

Cross‐Sector Collaboration in the High‐Poverty Setting: Qualitative Results from a Community‐Based Diabetes Intervention

“…; Steve et al. ). The health care system has traditionally engaged communities as a solitary organization, using a biomedical model that may not advance broader health promotion goals (Wade and Halligan ).…”