BEYOND GLYCAEMIC CONTROL: SOCIAL DETERMINANTS, PSYCHOLOGICAL BURDEN, AND EARLY COMPLICATIONS MARKERS AMONG YOUNG ADULTS WITH TYPE 1 DIABETES IN SELECT CLINICS IN KENYA

**Abstract** **Background** Young adults with type 1 diabetes (T1D) in low- and middle-income countries experience persistently poor glycaemic control despite improved insulin access. Evidence on the effects of social determinants of health (SDOH) on glycaemic control, complications, and psychological well-being remains limited, particularly in sub-Saharan Africa. We examined relationships between SDOH, psychological health, glycaemic control, and early complication markers among young adults with T1D in Kenya. **Methods** We conducted a multicentre cross-sectional study among 164 adults aged 18-34 years attending four diabetes clinics in Kenya. SDOH were assessed using a prespecified, context-informed questionnaire covering six domains. Psychological well-being was assessed using PAID, PHQ-9, and GAD-7. Clinical outcomes included HbA1c, a single urine albumin-to-creatinine ratio (UACR), and lipid profile. Associations between SDOH domains and clinical and psychological outcomes were evaluated using multivariable ordinal and binary logistic regression models adjusted for age, sex, and diabetes duration. **Findings** Mean age was 24.96+/-4.35 years and diabetes duration 7.26+/-5.70 years. Mean HbA1c was 11.5+/-3.44%, with only 4.9% achieving <7%. LDL cholesterol was above target in 56.1%, 64.0% had an elevated LDL/HDL ratio, and 28.0% had elevated UACR. Diabetes distress and clinically significant depressive symptoms affected 30.5% and 27.5%, respectively. Moderate-to-high SDOH burden was greatest for economic stability (76.8%), social/community context (52.4%), and food environment (43.9%). All SDOH domains showed positive but non-significant associations with HbA1c. Diabetes distress was associated with economic instability (aOR 1.42, 95% CI 1.17-1.72), healthcare system burden (1.45, 1.12-1.87), neighbourhood/physical environment burden (1.39, 1.07-1.80), and food environment burden (1.30, 1.03-1.64). Anxiety was associated with social/community (1.70, 1.14-2.53) and healthcare system burden (1.68, 1.19-2.36). Economic instability was associated with elevated UACR (1.40, 1.05-1.85). **Discussion** Young adults with T1D in Kenya experience substantial social and psychological burden alongside poor glycaemic control and early complication markers. Social disadvantage appears to influence kidney disease complications, and psychological well-being regardless of glycaemic control in our sample, underscoring the need to move beyond glucose-centered care. Poor glycaemic control was pervasive, which likely obviated any detectable differences by SDOH in this population. Ultimately, Integrated care addressing SDOH and mental health may support more sustainable long-term outcomes. Key words: Type 1 diabetes; Social determinants; glycemic control; complications, psychological health