Association Between Psychosocial Acuity and Glycemic Control in a Pediatric Type 1 Diabetes Clinic.
Joseph Wardell, Dana Albright, Claire Chang and 6 others
PMID 38456252WHAT IT FOUND
In young people with diabetes, medium, high, and critical psychosocial concern were associated with A1C increases of 0.17, 0.30, and 0.48 compared with no/low concern.
Key findings
01Compared with no/low psychosocial concern, medium, high, and critical concern were associated with A1C increases of 0.17, 0.30, and 0.48.
02High concern was the most common maximum psychosocial acuity level (35.8%), followed by medium concern (34.9%), no concern (17.4%), and critical concern (11.9%).
03Functional status/discharge follow-up was assessed in 77.9% of encounters, social/community/school support in 62.8%, and coping/mental health in 56.2%; coping/mental health was most often the highest concern.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The analysis used only patients who had both a social worker acuity evaluation and an A1C within 6 months, so many clinic patients were not included. Social work did not assess every patient, and the scale records only domains assessed during an encounter, so some social risk may be missed. Acuity was matched to the closest A1C within 6 months, so the psychosocial state may not have matched the glycemic measure. The study was retrospective and did not measure factors such as time spent with the social worker, household structure, parental employment, income, education, or marital status. Only three domains had enough data for separate mixed models; transportation/lodging, insurance/finances, housing, and cognitive function/mental status were not modelled separately. The design cannot show that psychosocial risk caused higher A1C or that addressing it would lower A1C.
Declared interests
One author reported consulting for T1D Exchange, grant funding from Lenovo, and medical advisory board membership for GoodRx. The article lists NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not read the A1C increases as proof that psychosocial risk caused worse control or that social work care will lower A1C. The study was observational, used records from patients who happened to have social work assessments, and did not randomise or test an intervention.