Association of Neighborhood Socioeconomic Disadvantage and Uptake of Diabetes Prevention Interventions

BACKGROUND: Intensive lifestyle change intervention (LCI) programs and metformin are recommended to prevent the progression of prediabetes to type 2 diabetes. While social drivers of health are known to influence access to preventive health care the impact of neighborhood socioeconomic disadvantage on the uptake of diabetes prevention interventions remains underexplored. OBJECTIVE: Examine the relationship between the social deprivation index and the use of diabetes prevention interventions among people with prediabetes. METHODS: We analyzed commercial and Medicaid claims data from the Maryland Medical Care Data Base (2017-2019) to identify claims for LCIs and metformin prescriptions and Social Deprivation Index (SDI) 2015 data to measure enrollees' neighborhood socioeconomic disadvantage and examine associations between one or more diabetes prevention interventions. An adjusted multinomial logistic regression model estimating relative risk ratios was used to compare the relationship between SDI quintiles and use of LCI only, LCI and metformin, and metformin only (reference). RESULTS: Among enrollees who used any intervention those living in neighborhoods with SDI scores in the fifth quintile had a significantly higher relative risk (RRR: 1.49; 95% CI: 1.12-1.99) of using LCI only versus metformin only compared with those living in neighborhoods with SDI scores in the first quintile. CONCLUSION: Enrollees with prediabetes living in neighborhoods with higher levels of socioeconomic disadvantage were more likely to use LCI and more likely to use LCI only compared with metformin only as a diabetes prevention intervention. These findings are relevant for states targeting diabetes prevention in communities of high need.