Associations between non-medical social needs and glycemic control among adults with type 2 diabetes in Zahedan, Southeast Iran
Social Determinants of Health,
Vol. 12 (2026),
1 Dey 2026
,
Page 1-7
https://doi.org/10.22037/sdh.v12i1.53087
Abstract
Background: Social determinants of health (SDOH) and non-medical needs play a critical role in diabetes management, particularly in less-developed regions where structural barriers are prevalent. This study examined the associations between non-medical needs and glycemic control among adults with type 2 diabetes mellitus (T2DM) in Zahedan, southeast Iran.
Methods: A cross-sectional study was conducted among 312 adults with T2DM. HbA1c values were categorized into controlled (<7%) and uncontrolled (≥7%) groups. Binary logistic regression identified independent predictors of poor glycemic control. Social determinants analyzed included food insecurity, employment status, housing problems, transportation barriers, and exposure to violence.
Results: The mean age of participants was (53.89 \pm 9.02) years, and 60.9% were female. A total of 84.6% reported frequently worrying about food running out. Significant predictors of uncontrolled HbA1c (≥7%) included older age (OR = 1.052, 95% CI: 1.008–1.098), unemployment (protective effect of employment: OR = 0.289, 95% CI: 0.111–0.753), lower education level (OR = 5.608, 95% CI: 1.936–16.241), and food insecurity (OR = 2.973, 95% CI: 1.503–5.880). Housing pest infestation ((P = 0.071)) and verbal violence ((P = 0.055)) demonstrated borderline associations.
Conclusion: Poor glycemic control among adults with T2DM in Zahedan is strongly shaped by social vulnerabilities, particularly food insecurity and unemployment, alongside socioeconomic and environmental stressors. These findings highlight the need for integrated, multisectoral interventions addressing social needs in resource-limited settings.
- Diabetes Mellitus, Type 2
- Glycated Hemoglobin
- Iran
- Social Determinants of Health
- Vulnerable Populations
How to Cite
References
1. International Diabetes Federation. IDF Diabetes Atlas. 10th ed. Brussels: International Diabetes Federation; 2021. Available from: https://idf.org/about-diabetes/resources/idf-diabetes-atlas-2021.
2. Centers for Disease Control and Prevention. National Diabetes Statistics Report 2022. Atlanta: Centers for Disease Control and Prevention; 2022. Available from: https://www.cdc.gov/diabetes/php/data-research/index.html.
3. International Diabetes Federation. IDF Annual Report 2022. Brussels: International Diabetes Federation; 2022. Available from: https://idf.org/media/uploads/2023/07/IDF_Annual_Report_2022_Final.pdf.
4. Ghaemi F, Hedayati F, Esteghamati A, et al. Trends of metabolic syndrome among Iranian patients with diabetes. BMC Endocrine Disorders. 2025;25:230. doi:10.1186/s12902-025-02050-8.
5. Mohammadi A, Goharimehr M, Darvishi A, et al. Economic burden of type 2 diabetes in Iran in 2022. BMC Public Health. 2025;25(1):35. doi:10.1186/s12889-024-21247-5.
6. American Diabetes Association. Standards of care in diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1–S350. doi:10.2337/dc24-SINT.
7. Gorst C, Kwok CS, Aslam S, et al. Long-term glycemic variability. Diabetes Care. 2015;38(12):2354–2369. doi:10.2337/dc15-1188.
8. Sartore G, Ragazzi E, Caprino R, et al. HbA1c variability and complications. Acta Diabetologica. 2023;60:721–738. doi:10.1007/s00592-023-02037-8.
9. World Health Organization. Social determinants of health. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/social-determinants-of-health Accessed [insert actual access date].
10. Walker RJ, Smalls BL, Egede LE. Social determinants in diabetes. Diabetes Research and Clinical Practice. 2015;110(2):193–201. doi:10.1016/j.diabres.2015.09.007.
11. Sargolzaei N, Mohebi MD, Hosaini SS, Farzad Z. Psychological well-being and social support. International Journal of High Risk Behaviors and Addiction. 2018;7(4):e67472. doi:10.5812/ijhrba.67472.
12. Khammarnia, Mohammad & Ghiasvand, Hesam & Javadi, Fateme & Adimi, Fatemeh. (2021). Equity in the Distribution of Health Resources: A Case Study in Southeast Iran. Shiraz E-Medical Journal. 22. 10.5812/semj.106392.
13. Jafari Sirizi M, Badpa F, Ahmadipour H. Screening for social determinants. Iranian Journal of Medical Sciences. 2023;48(1):106–107. doi:10.30476/IJMS.2022.94495.2594.
14. Hill-Briggs F, Adler NE, Berkowitz SA, et al. Social determinants and diabetes. Diabetes Care. 2020;44(1):258–279. doi:10.2337/dci20-0053.
15. Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults. Diabetes Care. 2012;35(12):2650–2664. doi:10.2337/dc12-1801.
16. Walker RJ, Smalls BL, Campbell JA, Egede LE. Impact of social determinants. Endocrine. 2020;68(1):9–20. doi:10.1007/s12020-020-02271-5.
17. Patel MR. Social determinants and diabetes management. Current Diabetes Reports. 2020;20:67. doi:10.1007/s11892-020-01354-4.
18. Karachaliou F, Simatos G, Simatou A. Diabetes care in low-income settings. Frontiers in Endocrinology. 2020;11:518. doi:10.3389/fendo.2020.00518.
19. Berkowitz SA, Karter AJ, Corbie-Smith G, et al. Food insecurity and glycemic control. Diabetes Care. 2018;41(6):1188–1195. doi:10.2337/dc17-1981.
20. Gordon B. Food insecurity and glycemic control. BioMed. 2022;2(2):170–180. doi:10.3390/biomed2020016.
21. Beltran S, Arenas DJ, Pharel M, et al. Food insecurity meta-analysis. Endocrinology, Diabetes & Metabolism. 2022;5:e315. doi:10.1002/edm2.315.
22. Rawshani A, Rawshani A, Franzen S, et al. Risk factors and outcomes. New England Journal of Medicine. 2018;379(7):633–644. doi:10.1056/NEJMoa1800256.
23. Kim SH, Lee SY, Kim CW, et al. Socioeconomic status and diabetes. Diabetes & Metabolism Journal. 2018;42(5):380–390. doi:10.4093/dmj.2018.0060.
24. Castillo-Laborde C, Hirmas-Adauy M, Matute I, et al. Access barriers. Public Health Reviews. 2022;43:1604796. doi:10.3389/phrs.2022.1604796.
25. Keene DE, Guo M. Structural inequities. Social Science & Medicine. 2018;197:71–77. doi:10.1016/j.socscimed.2017.11.051.
26. Hatef E, Kitchen C, Pandya C, et al. Social needs and healthcare utilization. Journal of Medical Systems. 2023;47:95. doi:10.1007/s10916-023-01990-9.
27. Sargolzaei N, Sarhadi S, Zouripour N, Maleki H. Social needs and cardiovascular disease risk. Health Scope. 2025;14(4):e164264. doi:10.5812/healthscope-164264.
- Abstract Viewed: 8 times