P-379: The hidden burden of type 1 diabetes in LMICs: social determinants and mental health in young adults in Kenya

Introduction

Young adults with Type 1 Diabetes (T1D) in low-resource settings face overlapping social and psychological burdens, yet the pathways linking social determinants of health (SDOH), mental health, and glycemic outcomes remain unclear.

Objectives

To evaluate the burden of SDOH and mental health disorders and examine their relationships with glycemic control among young adults with T1D in Kenya.

Methods

An analytical cross-sectional study among 164 young adults (18–34 years) across four diabetes clinics. SDOH were assessed across six domains and categorized as low, moderate, or high burden. Mental health outcomes included diabetes distress (PAID >40), depression (PHQ-9 ≥10), and anxiety (GAD-7 ≥10). Multivariable regression models examined associations between SDOH, psychological outcomes, and HbA1c.

Results

Mean age was 25 years, diabetes duration 7.3 years, and mean HbA1c 11.5%. Moderate–high SDOH burden was common across domains, particularly economic stability (76.8%) and healthcare access (79.3%). Psychological burden was substantial: 29.3% had diabetes distress, 27.5% depression, and 17.6% anxiety.

SDOH were strongly associated with diabetes distress, especially economic instability, healthcare system burden, and lower education attainment. SDOH domains were significantly associated with HbA1c, indicating a direct effect on glycemic control.

Conclusions

Young adults with T1D in Kenya experience high and overlapping burdens of social vulnerability and psychological distress. SDOH are key drivers of both diabetes-related distress and poor glycemic control, operating through parallel pathways rather than a single mediation chain. These findings highlight the need for integrated interventions addressing structural barriers alongside psychological support to improve diabetes outcomes.