Impact of a charitable medication program and social vulnerability index on clinical outcomes in uninsured adults with diabetes

BACKGROUND: Adults with diabetes mellitus (DM) and poor social vulnerability index (SVI) have been shown to have worse clinical outcomes with uncontrolled DM. Patient assistance programs (PAPs), free clinics, and charitable medication programs have been shown to improve hemoglobin A1C (HbA1c) for uninsured adults. OBJECTIVES: The primary objective of this study was to evaluate the impact of a charitable medication program on HbA1c as well as other clinical outcomes [blood pressure (BP), low-density lipoprotein (LDL) and body mass index (BMI)] in adults with type 2 diabetes mellitus (T2DM). Secondly, this study aimed to evaluate the impact of SVI on patient follow-up practices. METHODS: This retrospective chart review evaluated patients who were dispensed any T2DM-related medication from the Healthy Connections Medication (HCM) program at Hackensack Meridian Health (HMH) pharmacies from January 1st, 2023, to December 31st, 2024. Clinical outcomes were measured at baseline (30 days within fill date) and again within 6 months from baseline. All included and excluded patients' SVI were measured to determine vulnerability. RESULTS: Of 624 patients with T2DM medications, 87 met inclusion criteria. Statistically significant improvements were observed in HbA1c (11.30% to 9.60%; p < 0.001) and BP (SBP: 128 to 123 mmHg, p = 0.002; DBP: 78 to 75 mmHg, p = 0.005). Median LDL and BMI also decreased from baseline but missed statistical significance. Patients who did not have a repeat HbA1C within 6 months had a higher SVI (0.51 vs 0.45, p=0.01). CONCLUSION: Healthy Connections Medications improved all clinical outcomes with statistically significant reductions in HbA1c and BP within 6 months. Patients who did not obtain a repeat HbA1c had a higher SVI which may indicate a greater vulnerability among those patients who did not follow-up. Future studies should examine the implications of SVI and patient follow-up.