Assessing the relationship between neighborhood factors and diabetes related health outcomes and self-care behaviors

Brittany L. Smalls, Chris M. Gregory, James S. Zoller, Leonard E. Egede

Studies have shown that community and neighborhood characteristics can impact health outcomes of those with chronic illness, including T2DM. Factors, such as crime, violence, and lack of resources have been shown to be barriers to optimal health outcomes in diabetes. Thus, the objective of this study is to assess the effects of neighborhood factors on diabetes-related health outcomes and self-care behaviors. Adult patients (N = 615) with type 2 diabetes mellitus (T2DM) were recruited from an academic medical center and a Veterans Affairs medical center in the southeastern United States. Validated scales and indices were used to assess neighborhood factors and diabetes-related self-care behaviors. The most recent HbA1c, blood pressure, and LDL cholesterol were abstracted from each patients' electronic medical record. In the fully adjusted model, significant associations were between neighborhood aesthetics and diabetes knowledge (β = 0.141) and general diet (β = -0.093); neighborhood comparison and diabetes knowledge (β = 0.452); neighborhood activities and general diet (β = -0.072), exercise (β = -0.104), and foot care (β = -0.114); food insecurity and medication adherence (β = -0.147), general diet (β = -0.125), and blood sugar testing (β = -0.172); and social support and medication adherence (β = 0.009), foot care (β = 0.010), and general diet (β = 0.016). Significant associations were also found between neighborhood violence and LDL Cholesterol (β = 4.04), walking environment and exercise (β = -0.040), and social cohesion and HbA1c (β = -0.086). We found that neighborhood violence, aesthetics, walking environment, activities, food insecurity, neighborhood comparison, social cohesion and social support have statistically significant associations with self-care behaviors and outcomes to varying degrees. However, the key neighborhood factors that had independent associations with multiple self-care behaviors and outcomes were food insecurity, neighborhood activities and social support. This study suggests that food insecurity, neighborhood activities, aesthetics, and social support may be important targets for interventions in individuals with T2DM.