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Headshot of Dr. Berkowitz
Dr. Seth A. Berkowitz

A research team led by Seth A. Berkowitz, MD, MPH has received a five-year, nearly $3 million R01 award from the U.S. National Institutes of Health to better understand how addressing health-related social needs improves health outcomes for people with type 2 diabetes. The team includes investigators in the department of biostatistics and at OCHIN, a nonprofit organization that provides information technology support to community health centers.

According to Dr. Berkowitz, health-related social needs, including food insecurity, housing instability, and transportation barriers, affect more than 6 million people with type 2 diabetes. Individuals with type 2 diabetes who have unmet social needs are more likely to have more blood sugar highs and lows, high blood pressure, and high LDL cholesterol. As a result, they are at higher risk for complications of diabetes, including kidney disease and heart disease.

Since unmet social needs are one of the main reasons that individuals who are systematically marginalized based on race, ethnicity, and income are at higher risk for complications, the findings of this research may have important implications for advancing health equity.

“When you have type 2 diabetes, there is a lot you are asked to do — take medications, change your diet, increase exercise. Adding food insecurity and other barriers just makes it that much harder to stay healthy,” said Berkowitz.

Clinics and doctor’s offices may offer services to patients or refer them to other agencies that offer services to help with meeting unmet social needs. Services could include, for example, referrals to food pantries, help with securing housing, and free transportation to medical appointments.

Though it makes sense, evidence about whether these services improve health for people with type 2 diabetes is lacking. Additionally, little available research has examined which social needs are most pressing. What services should health care providers offer if they want to have the greatest positive impact on their patients’ health?

To answer this question, Dr. Berkowitz plans to examine a newly available source of electronic health record data, following patients with type 2 diabetes over time in a way that has not previously been possible. His research team will employ both standard epidemiological methods and innovative machine learning to help them uncover patterns between all the different factors in the data — patients’ age, gender, race, or ethnicity, unmet social needs, use of services offered by clinics, and health outcomes — to determine which social needs or services are the most important to improving patient health.

Access to the electronic health record data needed for the project is possible through a partnership with OCHIN, which to pull data from a repository that includes 18,000 patients with type 2 diabetes at more than 600 community health center clinics across the U.S.

Once the health record data has been analyzed, researchers at OCHIN will interview patients, providers, and staff from the 10 clinics where patients showed the greatest improvement in health outcomes.

By combining health record data with information from interviews, the research team at UNC hopes to develop an in-depth understanding of how services at some clinics have improved patient heath, to help other providers offer similarly impactful programs.

“In this research, we hope to learn how to better address the substantial structural barriers too many people face when trying to stay healthy,” said Berkowitz.

Seth A. Berkowitz, MD, MPH, is a research fellow at the Center for Health Promotion and Disease Prevention and assistant professor at the UNC School of Medicine.

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