SUN-860 - Association of Family and Community Support with Glycemic Control Among Dominican Adults with Type 2 Diabetes in A Primary Care Setting

Background:
Type 2 diabetes mellitus (T2DM) affects approximately 17% of Dominican adults, yet glycemic control predictors remain understudied in low-resource Hispanic primary care settings. While metabolic risk factors are established, social determinants, particularly the effects of family vs community support, and health information access, remain poorly understood in Latin American contexts where collectivist cultural values strongly influence health behaviors.

Methods:
We conducted a cross-sectional study of 77 T2DM adults receiving care at a primary care center in San Francisco, Dominican Republic. Participants aged ≥18 with T2DM for ≥1 year and on oral hypoglycemic therapy were randomly selected. Sociodemographic and clinical data were collected via a structured questionnaire, and labs including fasting blood glucose, HbA1c, lipid profile, and renal function were obtained from medical records. Therapeutic adherence and social support were assessed using the validated Therapeutic Adherence Scale in Type 2 Diabetes Mellitus (EATDM-III), a 36-item instrument with domain-specific scores for family support (items 18–27), community support (items 28–33), and information (items 34–36) . Glycemic control was defined as HbA1c < 7%. Continuous variables were compared using Mann–Whitney U test, and categorical variables using chi-square or Fisher’s exact test.

Results:
Among 77 participants, 38% had poor glycemic control. As expected, poor control was associated with higher fasting glucose (193±72 vs 118±29 mg/dL, p< 0.001), total cholesterol (203±39 vs 169±35 mg/dL, p< 0.001), LDL (119±39 vs 101±26 mg/dL, p=0.034), and lower HDL (45±13 vs 55±12 mg/dL, p< 0.001). Paradoxically, poor control was associated with higher family support scores (24±10 vs 20±8, p=0.008) and higher information domain scores (9.7±3.0 vs 8.0±3.5, p=0.030), but significantly lower community support scores (3.8±3.8 vs 6.3±4.3, p=0.013). No significant differences were observed by BMI, eGFR, hypertension prevalence, number of medications, age, sex, or marital status.

Conclusion:
T2DM patients exhibited expected metabolic derangements with poor control but paradoxical social support patterns. The higher family support/information scores in the poorly controlled cohort may reflect reverse causality, whereby deteriorating glycemic status prompts increased family involvement and patient education. Conversely, better glycemic control with higher community support aligns with evidence that community-based resources improve diabetes outcomes in this population. Support quality and type, rather than quantity alone, may be critical determinants of glycemic control. Community-based interventions extending beyond the family unit may be particularly beneficial. Prospective studies are needed to clarify temporal relationships between social support forms and diabetes outcomes.

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