31-LB: The Relationship between Improvements in Glycemic Control following a Digital Health Intervention and the Food Environment in a Medicare Advantage Population

Diabetes is a complex disease that is influenced by social determinants of health (SDOH). An inadequate food environment, as a function of socioeconomic status and proximity to food retailers, has been associated with both increased prevalence of diabetes and barriers to diabetes self-management. This work examined the relationship between improvements in glycemic control as a result of a digital health intervention and the food environment in Medicare Advantage members at risk for diabetes-related complications (hemoglobin A1c [A1c] ≥ 8%). Participants enrolled in the Vida Health Diabetes Management program as part of their medical insurance benefit and utilized remote sessions with Registered Dietitians and Certified Diabetes Care and Education Specialists as well as content related to goal-setting to account for SDOH factors. The 2010 USDA Food Access Research Atlas was used to identify areas of low income and the absence of a food retailer within 0.5 or 1 urban and 10 rural miles (LILA). Participants were included if they had a laboratory A1c between -365 to -1 and 60 to 365-days of enrollment. Participants with baseline A1c ≥ 8.0 (n=430, 229 F, 68.9 y) demonstrated a decrease of -0.90 points (SD 1.71, p<0.001). Thirty-five percent resided in LILA areas at the 0.5, and twenty percent at 1 mile distance. Participants who resided in LILA areas had higher baseline A1c (0.5 difference: 0.37 (p=0.02), 1 difference: 0.51 (p=0.005)). Those with baseline A1c ≥ 9.0 (n=216, 120 F, 67.8 y) demonstrated a decrease of -1.38 points (SD 1.96, p<0.001). Thirty-nine percent resided in LILA areas at the 0.5, and twenty-three percent at 1 mile distance. Baseline A1c differences were not observed. Differences in improvements in A1c based on LILA were not observed (p’s > 0.05). Irrespective of LILA residence, the Vida Health program demonstrated significant improvements in glycemic control within 1 year in a high-risk Medicare Advantage population.