188-OR: Association of Social Determinants of Health with Efficacy of Metabolic Bariatric Surgery (MBS) vs. Medical Therapy (MT) for Type 2 Diabetes
Authors: PATTI MARY-ELIZABETH , HU BO , WANG HANNA , SARIG YAEL , SIMONSON DONALD C. , FOSTER KATHY , WOLFS DANIELLE , ARTERBURN DAVID , O'BRIEN MATTHEW J. , VERNON ASHLEY H. , JAKICIC JOHN M. , KASHYAP SANGEETA R. , AMINIAN ALI , SCHAUER PHILIP , CUMMINGS DAVID E. , GOURASH WILLIAM F. , COURCOULAS ANITA , KIRWAN JOHN P. 
Published: June 2024

Introduction & Objective: Social determinants of health (SDOH) are known to impact metabolic health. We hypothesized unfavorable SDOH would adversely impact glycemic and weight responses to MBS vs. MLI for T2D.
Methods: The ARMMS-T2D cohort includes patients with T2D randomized to MBS or MLI with 7-12 years of follow-up data on HbA1c and weight. At study end, participants completed a questionnaire assessing SDOH measures: PRAPARE, Hunger Vital Signs (HVS), AHC Health-Related Social Needs (AHC-HRSN), & Health Literacy (BRIEF). Participant addresses informed area deprivation index (ADI), a metric of social vulnerability. Data were analyzed using linear mixed-effect models.
Results: Of 262 participants with &lt;u&gt;&gt;&lt;/u&gt;7 year follow-up, 169 (65%) completed the survey; completers did not differ from noncompleters for age, sex, or race. SDOH measures did not differ between groups after adjusting for study site. In cross-sectional analyses (end-of-study), scores indicating higher deprivation or food insecurity, lower medication adherence, & lower health literacy were associated with higher HbA1c: HVS (p&lt;0.001), BRIEF (p=0.02), MMAS4 (p&lt;0.001), & AHC-HRSN (p=0.02), with trend for PRAPARE (p=0.055). Relationships differed by group for HVS, with greater impact for MBS (p=0.02). There were no significant relationships between SDOH and BMI. Higher baseline ADI was associated with greater decline in HbA1c over time (p=0.04) in MBS but did not remain after control for baseline HbA1c and site. Higher baseline ADI was associated with less weight loss over time (p=0.009); this was greater in MLI (p=0.008) and remained after adjustment for baseline weight and site (p=0.002).
Conclusion: Individuals with higher deprivation indices at randomization had less weight loss over time. These associations were stronger for the MLI group, suggesting SDOH may exert greater adverse impact when ongoing need for anti-diabetes medical therapy is greater.

Disclosure
M. Patti: Research Support; Dexcom, Inc. Consultant; Hanmi Pharm. Co., Ltd., MBX Biosciences. Other Relationship; Fractyl Health, Inc. Consultant; AstraZeneca, Spruce Biosciences. B. Hu: None. H. Wang: None. Y. Sarig: None. D.C. Simonson: Stock/Shareholder; Phase V Technologies, Inc. Advisory Panel; GI Windows. K. Foster: None. D. Wolfs: None. D. Arterburn: None. M.J. O'Brien: None. A.H. Vernon: None. J.M. Jakicic: Research Support; Epitomee. Advisory Panel; Wondr Health. Consultant; Education Initiatives, Inc. S.R. Kashyap: Research Support; Fractyl Health, Inc. Advisory Panel; GI Dynamics. Research Support; Janssen Pharmaceuticals, Inc. A. Aminian: Research Support; Medtronic. Consultant; Medtronic, Ethicon, Inc. Research Support; Ethicon, Inc. Advisory Panel; Eli Lilly and Company. P. Schauer: Research Support; Ethicon, Inc. Other Relationship; Ethicon, Inc. Research Support; Medtronic. Other Relationship; Medtronic, Novo Nordisk. Advisory Panel; Lilly Diabetes, GI Dynamics, Heron. Stock/Shareholder; Mediflix, SE Healthcare. Other Relationship; Klens. Advisory Panel; Persona, Keyron. Stock/Shareholder; Metabolic Health International LTD. D.E. Cummings: None. W.F. Gourash: None. A. Courcoulas: Research Support; Allurion, Eli Lilly and Company. J.P. Kirwan: None.

Funding
National Institutes of Health (U01 DK114156)