OBESOGENIC MEDICATION USE IN TYPE 2 DIABETES: PREVALENCE AND ASSOCIATIONS WITH SOCIAL DETERMINANTS OF HEALTH AND HEALTHCARE UTILIZATION

Abstract

Diabetes affects 38.4 million people in the U.S. with 90-95% having type 2 diabetes (T2DM). Obesogenic medications, which contribute to weight gain, can worsen T2DM and disproportionately impact patients due to health disparities of SDOH. Obesogenic medications tend to be cheaper and older while non-obesogenic alternatives tend to be newer and more expensive. This dissertation explored the prevalence of obesogenic medication use and their relationship with social determinants of health (SDOH) and healthcare utilization outcomes in adults with T2DM through three studies. The first study examined the process on how major healthcare organizations (ACC/AHA, ADA, AAFP) defined and addressed SDOH in clinical practice and research. The ACC/AHA focused on standardizing SDOH cardiovascular care data, the ADA reviewed literature to identify effective interventions for diabetic individuals, and the AAFP provided community screening tools through the Everyone Project. The findings highlighted the complexity of standardizing SDOH approaches across healthcare systems. The second study analyzed the prevalence of obesogenic medication and its association with SDOH using the All of Us database, showing that 42.99% of participants were using at least one obesogenic medication. Although antidiabetic drugs were the most commonly used (28.51%), antipsychotics were the least prevalent (4.60%). Stepwise logistic regression revealed that SDOH factors, such as education, income, and employment, were associated with lower odds of obesogenic medication use (OR = .816, 95% CI: 0.674–0.988, P = .037). The third study examined obesogenic medication use and healthcare utilization using the NHANES database, finding that 64.9% of individuals with T2DM were on at least one obesogenic medication with antidiabetic drugs being the most used (50.2%). Obesogenic medication users had a higher likelihood of hospitalization and increased healthcare utilization. Together, the last two studies showed that over two-thirds of T2DM patients are obese with obesogenic medications prevalent yet tied to poor glycemic control. The studies emphasized the need for access to non-obesogenic medications among those with the highest burden across SDOH, and the impact of these medications on increased healthcare utilization. Reducing reliance on obesogenic medications could improve diabetes management and alleviate healthcare burden. By utilizing two datasets, NHANES (nationally representative) and All of Us (diverse and vulnerable populations), this dissertation provides critical insights into addressing health disparities and optimizing diabetes pharmacological care.