The Associations Between Neighborhood Safety and Address Stability With HbA1c Levels Among Adults With Diabetes

Nonmedical variables such as neighborhoods and economic status impact health care management for patients with diabetes. This study aimed to discover which nonmedical drivers of health (NMDOH) were associated with responses to a diabetes intervention among a sample of adults with diabetes who previously participated in a quality improvement program (QI) to improve diabetes outcomes.

This study included 666 participants from the QI program. We used retrospective HbA1c data from the program to categorize patients as responders (values reduced by ≥ 0.5% postintervention) or nonresponders (values reduced by < 0.5% postintervention). Data were collected from a public record NMDOH dataset between December 2023 and October 2024 and linked to each patient's demographic and clinical data in the electronic medical record. Participants with complete NMDOH and clinical/demographic data were analyzed (n = 473). ANOVA and Fisher's exact tests examined differences in NMDOH factors between responders versus nonresponders.

The mean age was 55.5 years, mean preintervention HbA1c was 9.0%, mean postintervention HbA1c was 8.3%, and mean change in HbA1c was -0.72%. Fifty-one percent (n = 243) of patients were postintervention responders. We found that variables related to crime and address stability (frequency of address change) in the "neighborhood and built environment" domain were significantly associated with responses to the intervention.

Neighborhood crime and more frequent address changes appear to impact patients' responses to the diabetes QI intervention. Future interventions should include social support navigators to identify and address neighborhood stressors and socioeconomic barriers that may impact patient outcomes.