Simultaneous Heart-Kidney Transplantation for Ebstein's Anomaly: A Viable Treatment Option in Latin America.

Diabetes is a public health concern, with a worldwide prevalence of 10.5% in 2021, projected to rise to 12.2% by 2045. The Middle East and North Africa (MENA) region reports the highest regional prevalence, estimated at 16.2% in 2021, with rates expected to increase to 19.3% by 2045. Diabetes is a leading contributor to morbidity and mortality and places substantial economic burdens on health care systems globally. Effective diabetes management is multifaceted, requiring not only traditional medical and lifestyle interventions but also a comprehensive understanding of the social determinants of health (SDOH) that influence disease risk and outcomes. SDOH encompass the conditions in which individuals live, work, learn, and engage in leisure activities, all of which significantly impact health outcomes. Addressing SDOH to reduce health disparities and improve disease management has been strongly advocated by several major health organizations, including the United States Department of Health and Human Services, the World Health Organization, and the American Diabetes Association. Material needs, a subset of SDOH, include the essential resources required for individuals to maintain health and well-being, including access to housing, utilities, transportation, and medication, as well and confidence in filling health forms. Material need insecurities have been linked to poor diabetes outcomes, through limited access to nutritious food, medications, and health care resources. Understanding the temporal relationship between these insecurities and diabetes management is crucial for developing effective interventions. Food insecurity is defined as the lack of consistent access to nutritionally adequate and safe foods. It is intertwined with material need insecurities, contributing to poor health outcomes and overall quality of life, particularly for individuals with chronic diseases such as diabetes. Food insecurity is often a symptom of broader material need insecurities, whereby the latter can limit access to adequate and nutritious food, thereby contributing to food insecurity. Limited access to nutritious food can lead to poor dietary choices, elevated blood glucose levels, and increased diabetes related complications. These constraints may also lead to cost-related medication underuse, which further impairs diabetes control. The interplay between material needs security, food security, and diabetes management is complex and influenced by various factors, including economic status, education, and health literacy. Lebanon, a country located in the MENA region, has one of the highest diabetes prevalence in the region, estimated at 15%. The socioeconomic and security turmoil currently affecting Lebanon exacerbates the situation, as it has led to increased material and food insecurity, further complicating diabetes management and prevention efforts. This crisis is characterized by a severe economic collapse, currency devaluation, and reduced purchasing power, all of which have contributed to rising poverty and limited access to basic services. Recent studies revealed that a significant portion of the Lebanese population is experiencing moderate to severe food insecurity, a sharp increase from previous years. SDOH, including material and food security, as well as other culturally relevant factors like fatalism have been studied in Lebanese people with type 2 diabetes (T2DM) of low socioeconomic status. All these SDOH have been found to significantly impact clinical and mental health outcomes as well as quality of life. For instance, diabetes fatalism, a construct deeply tied to the Arabic culture, is characterized by emotional distress, religious determinism, and reduced self-efficacy. In the Lebanese context, both total fatalism and its emotional distress subscale have emerged as independent predictors of poor glycemic control, with higher scores directly correlating to elevated HbA1c levels. However, the interrelated effect of material needs and food security in the context of diabetes has not been explored. Thus, the aim of this study is to investigate the relationship between material needs security and food security among Lebanese adults with T2DM of low socioeconomic status.