P-194: Social determinants of health in pediatric type 1 diabetes: association between social risk score and metabolic outcomes
S Uzun Karaüzüm, G Demir, G Akdaş, D Özalp Kızılay, S Özen, D GökşenAbstract
Introduction
Social determinants of health play a key role in metabolic control and diabetes-related complications in children with type 1 diabetes (pWD), yet data in high-risk pediatric populations remain limited.
Objectives
This study aimed to evaluate the clinical, metabolic, and sociodemographic characteristics of children and adolescents with T1D referred to social services, and to assess the association between social risk burden and metabolic control.
Methods
Forty-eight patients were retrospectively analyzed. A composite social risk index based on nine domains (including socioeconomic status, parental education, family structure, psychiatric comorbidities, and housing instability) was used to classify patients into low (0–1), moderate (2–3), and high (≥4) risk groups. Glycemic outcomes and CGM metrics (ISPAD 2024) were compared.
Results
Among 48 patients, 38 had established T1D (mean age 13.9±3.4 years), of whom 73.7% had DKA at diagnosis. Mean HbA1c was 11.0±2.8%, with 76.3% showing poor metabolic control (≥9%). The most prevalent social risk factors were low parental education (63.2%), psychiatric disorders (44.7%), single-parent family structure (39.5%), and low socioeconomic status (36.8%). The leading reason for referral to social services was treatment non-adherence (97.5%), followed by adolescent-related adherence challenges (50%) and psychological problems (15.8%). In patients with available CGM data (n=19), mean glucose was 206.4±50.4 mg/dL, GMI 8.3±1.2%, and TIR 43.1±19.8%. TAR levels (1 and 2) were 25.9±6.3% and 28.6±20.6%, while TBR levels (1 and 2) were 1.7±1.9% and 0.6±0.8%, respectively. CV was 37.0±5.2%. HbA1c differed significantly across social risk groups (p=0.021), with progressively higher levels from low to high risk (median 9.45% to 13.70%, p=0.006).
Conclusions
High social risk burden is associated with poorer metabolic control in pediatric T1D. Structured social risk assessment and multidisciplinary care are essential to improve outcomes in vulnerable populations.