1849-LB: Social Determinants of Health and Early-Onset Type 2 Diabetes—A Qualitative Study

Objective: To explore how social determinants of health (SoDH) affect disease perception and diabetes care in Koreans with early-onset type 2 diabetes (T2D).

Methods: A qualitative research study included 35 Koreans (54.29% men) out of 83 contacts, diagnosed with T2D prior to 40 years of age. Interviews lasted 40 to120 minutes, occurring between June 2023 and February 2024. The verbatim transcriptions of semi-structured interview data were analyzed using conventional content analysis.

Findings: The primary means of diabetes awareness was (bi)-annual free check-ups (42.86%) provided by the Korea National Health Insurance Service, followed by recognition of symptoms (22.86%), visits to the emergency room or clinic due to acute illness (22.86%), and follow-up check-ups after gestational diabetes (8.57%). Major themes identified were doomed, self-blamed or depressed. With a family history of diabetes, the patients often felt doomed or blamed themselves for not adopting a healthier lifestyle earlier despite being aware of their risk. Others without family history reported having limited knowledge of T2D. They expressed a sense of "why me," leading to negative emotions. Connecting with peers in the eCommunity brought relief, making them feel less isolated in their experiences. Since Koreans with early-onset T2D felt flawed due to a familial risk and their diagnosis, they felt inadequate about intimate relationships, including marriage and pregnancy. The timing and extent of disease disclosure to a partner depended on the level of relationship.

Conclusions: SoDH play a significant role in early screening, diagnosis and care possibly influencing diabetes remission. Peer norms and familial risk affect diabetes perception in this population. Emphasizing weight loss or a healthy lifestyle may unintentionally deepen the stigma by reinforcing feelings of self-blame. Clinical discussion and messages need to be framed to mitigate self-blame and encourage motivation for positive change.