In conjunction with Stanford Medical School, researchers Sanjay Basu, MD, PhD, and Rajiv Narayanaswamy, MBBS, MBA, have recently published a study that connects social determinants of health to the formation of uncontrolled type 2 diabetes mellitus (T2DM), defined as hemoglobin A1c greater than 9%.1

The research is based on terabytes of area-level information and claims data from more than one million US patients with type 2 diabetes. The study explores the exact social determinants that help lead to the formation of uncontrolled type 2 diabetes. Social determinants of health are broadly defined as a wide array of conditions that can deeply affect both health conditions and health outcomes, including addictions, early life conditions, food and food insecurities, gender, race, social exclusion, social support, stress, and work.

The recent publication represents the first study to offer a predictive model based on social determinants of health at the census tract level. The study found the average risk for an individual in the United States would equal a 17.8% predicted probability that their diabetes would be uncontrolled.

“This is a major peer-reviewed study that sheds light on an important aspect of T2DM causality, and addressing them has the potential to save the US healthcare system billions,” says Narayanaswamy. “Social determinants are often the key to both prediction and prevention, and this research highlights the importance of assessing social determinants of health at the census tract level to more accurately predict the risk of uncontrolled T2DM of a given population.

“For hospitals entering into contract negotiations with payors, having this data is crucial,” adds Narayanaswamy. “Furthermore, the model fundamentally changes basic strategic approaches to patient access programs across the country and will have significant influence on how and where medications are marketed in the future.”


  1. Basu S, Narayanaswamy R. A prediction model for uncontrolled type 2 diabetes mellitus incorporating area-level social determinants of health. Med Care. 2019;57(8):592–600; doi:10.1097/mlr.0000000000001147.

Featured image:

Handheld glucose monitor. Photo © Maya Kruchankova courtesy Dreamstime (lD 85464437).