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Project Title

SOCRATES: SOCial Risk and diAbetes ouTcomEs Study

Funding Dates



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. Thus, they are at higher risk for complications of diabetes, including kidney disease and heart disease. Clinics and doctor’s offices may offer or direct patients to services such as referrals to food pantries, help with secure housing, and free transportation to medical appointments, to help with meeting unmet social needs. However, little evidence exists about whether these services improve health for people with type 2 diabetes. The goal of this study is to better understand which social needs or services are most important to improving patient health. Through an examination of electronic health record data covering extended periods of time, this study will seek out patterns between patients’ demographics, unmet social needs, use of services, and health outcomes. Following the examination of the health record data, the research team will interview patients, providers, and staff to gain an in-depth understanding of how services might improve patient health. The findings will be used to help other providers offer similarly impactful services.

Research Areas 

Cardiovascular Health, Obesity, and Diabetes
Health Equity
Healthy Food Access

Principal Investigator

Seth A. Berkowitz, MD, MPH


National Institutes of Health