Background/Purpose: One-third of adults with Type 2 diabetes (T2D) also have arthritis. West Virginia (WV), the 3rd most rural US state, has the highest prevalence of arthritis (34.2%) and T2D (18.3%). Yet, the additive impact of these 2 comorbid conditions on self-care activities during the COVID-19 pandemic is unknown. This study determined if self-management activities, healthcare provider (HCP) counseling, and other health factors differed by arthritis status in WV adults with T2D during the pandemic.

Methods: Adults, aged 18+ with T2D, from the WV Clinical and Translational Science Institute COVID-19 Patient Data Registry completed a statewide online survey between 10/2021-11/2022. Data were collected on socio-demographics, self-reported arthritis (yes/no), healthcare visits, T2D self-care using the Summary of Diabetes Self-Care Activities scale (SDSCA) (healthy diet, exercise, blood sugar monitoring, medication adherence), counseling received from HCPs on self-care activities (SDSCA), global physical and mental health (PROMIS® Scale v1.2 with scores standardized to US population), pain severity (0=no pain, 10=worst pain), diabetes distress (Diabetes Distress Screening Scale), pandemic-related stress (Perceived Stress Scale-Covid), and social support. Chi-square, Fisher exact, Mann-Whitney, and independent t-tests examined the relationship between each variable and arthritis status.

Results: The mean age of the 1541 respondents (61% women) was 60 ± 12 years (range 20-92). Forty-four percent had comorbid arthritis and T2D. Adults with arthritis were older, women, and white; with lower income/education; and public insurance, than those without arthritis (p-values < 0.01). Adults with T2D and arthritis were more likely to participate in office (p=0.02) and telephone (< 0.001) healthcare visits than those with T2D. Self-care activities did not differ between the 2 groups except for exercise; adults with arthritis exercised fewer days/week (arthritis 2.0 ± 2.0, no arthritis 2.4 ± 2.0, p< 0.001). The HCPs were more likely to counsel adults with arthritis and T2D on diet, exercise, blood sugar, and medications than those with T2D (p-values ≤0.02). Pain severity was higher in those with arthritis and T2D (p< 0.001). Mean global physical and mental health scores were below the US mean in all respondents, with poorer physical and mental health reported by those with arthritis and T2D compared to those with T2D (p-values < 0.001). Although T2D distress did not differ between the 2 groups, pandemic-related stress (p< 0.01) and social support (p< 0.001) were higher in those with arthritis and T2D.

Conclusion: The prevalence of self-reported comorbid arthritis and T2D in WV was higher than the US average. Among adults with T2D, comorbid arthritis was an indicator of a more vulnerable (e.g., older, lower income/education) and less healthy (e.g., worse physical/mental health, greater pain, pandemic stress) population that was less likely to exercise despite HCP counseling. Additional strategies are needed to motivate them to engage in regular exercise. Further research is needed to reduce the barriers to exercise for adults with comorbid arthritis and T2D, perhaps by leveraging their social support from family and friends.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-arthritis-on-self-management-activities-of-west-virginia-adults-with-type-2-diabetes-during-the-covid-19-pandemic/