Geographic and social factors are related to increased morbidity and mortality rates in diabetic patients

Weng, C.; Coppini, D.V.; Sönksen, Peter H.

doi:10.1046/j.1464-5491.2000.00352.x

Cited by 81 publications

(78 citation statements)

References 19 publications

(21 reference statements)

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“…This argument would lead to the conclusion that higher socioeconomic status is associated with worse metabolic control, which has not been observed [32]. When we tested subcohorts defined by parameters with some socioeconomic impact (age, sex, area of residency), the difference between SMBG and non-SMBG in terms of outcome remained.…”

Section: Hr (95% Ci)mentioning

confidence: 92%

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

et al. 2005

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Aims/hypothesis: The aim of this study was to obtain epidemiological data on self-monitoring of blood glucose (SMBG) in type 2 diabetes and to investigate the relationship of SMBG with disease-related morbidity and mortality. Methods: The German multicentre Retrolective Study 'Self-monitoring of Blood Glucose and Outcome in Patients with Type 2 Diabetes' (ROSSO) followed 3,268 patients from diagnosis of type 2 diabetes between 1995 and 1999 until the end of 2003. Endpoints were diabetesrelated morbidity (non-fatal myocardial infarction, stroke, foot amputation, blindness or haemodialysis) and all-cause mortality. SMBG was defined as self-measurement of blood glucose for at least 1 year. Results: During a mean followup period of 6.5 years, 1,479 patients (45.3%) began SMBG prior to an endpoint and an additional 64 patients started SMBG after a non-fatal endpoint. Interestingly, many patients used SMBG while being treated with diet or oral hypoglycaemic drugs (808 of 2,515, 32%). At baseline, the SMBG cohort had higher mean fasting blood glucose levels than the non-SMBG cohort (p<0.001), suggesting that insufficient metabolic control was one reason for initiating SMBG. This was associated with a higher rate of microvascular endpoints. However, the total rate of nonfatal events, micro-and macrovascular, was lower in the SMBG group than in the non-SMBG group (7.2 vs 10.4%, p=0.002). A similar difference was found for the rate of fatal events (2.7 vs 4.6%, p=0.004). Cox regression analysis identified SMBG as an independent predictor of morbidity and mortality, with adjusted hazard ratios of 0.68 (95% CI 0.51-0.91, p=0.009) and 0.49 (95% CI 0.31-0.78, p=0.003), respectively. A better outcome for both endpoints was also observed in the SMBG cohort when only those patients who were not receiving insulin were analysed. Conclusions/interpretation: SMBG was associated with decreased diabetes-related morbidity and all-cause mortality in type 2 diabetes, and this association remained in a subgroup of patients who were not receiving insulin therapy. SMBG may be associated with a healthier lifestyle and/or better disease management.

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Section: Hr (95% Ci)mentioning

confidence: 92%

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

et al. 2005

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“…In the general population, mortality is greater in those from a more disadvantaged socioeconomic situation, principally as a result of cardiovascular disease [16]. In the presence of diabetes, however, mortality rates are significantly greater in individuals who live in relatively deprived areas [17]. Furthermore, depression has been found to be associated with a 2.3-fold increase in mortality vs no depression in individuals with diabetes [18].…”

Section: Introductionmentioning

confidence: 99%

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

et al. 2017

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Aims/hypothesis The aim of this study was to determine whether social deprivation in the presence of diabetes is an independent predictor of developing a foot ulcer and separately of mortality. Methods This was a primary-care-based retrospective analysis of 13,955 adults with type 1 (n = 1370) or type 2 (n = 12,585) diabetes after a median follow-up of 10.5 years. Demographic characteristics, indices of social deprivation and clinical variables were assessed at baseline. The primary outcomes were new foot ulceration (in those without a previous history of foot ulcers) and all-cause mortality. Cox proportional hazard models were used to describe the associations among foot ulceration, social deprivation and mortality. Results The mean age of the population was 69.4 (range: 16-89) years. The incidence of foot ulceration was greater in individuals with type 2 (8.6%) compared with type 1 diabetes (4.8%). Occurrence was similar by sex, but increased with age and deprivation index. Individuals in the highest quintile of deprivation were 77% more likely to develop a foot ulcer compared with those in the lowest quintile (OR 1.77 [95% CI 1.45, 2.14], p < 0.0001). Overall, 2946 (21.1%) deaths were recorded. Compared with individuals without a foot ulcer, the development of a foot ulcer was associated with a higher age-and sex-adjusted mortality rate (25.9% vs 14.0%), and a 72% (HR Conclusions/interpretation This study confirms the high mortality rate in individuals with diabetes-related foot ulcers. In addition, socioeconomic disadvantage was found to be an independent effect modifier, contributing to an increased burden of mortality in people with diabetes who develop foot ulceration. In light of this, and as diabetes service configurations are orientated for the next 5-10 years, modelling of foot ulceration risk needs to take socioeconomic disadvantage into account.

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“…SES has been associated with DFD, whereby lower SES status correlated with higher DFD prevalence [45,53,67]; with similarities as certain study types and methods demonstrated significant findings.…”

Section: Socio-economic Status and Diabetic Foot Disease Developed Comentioning

confidence: 81%

“…Furthermore, across all hospitalisations, Aboriginal and Torres Strait Islanders residing in lower SES areas had higher admission levels, again reflecting a causal link between social factors and DFD hospitalisation ( Figure 2). here is existing literature in developed countries [45,67] demonstrating a 1.7 fold increased risk of experiencing DFD when living in disadvantaged areas [53]. In a similar Australian study, those who resided in the most disadvantaged areas had higher rates of DFD-related hospitalisation [71].…”

Section: Diabetic Foot Disease and Socio-economic Statusmentioning

confidence: 92%

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Socio-Economic, Geographic, and Aboriginal and Torres Strait Islander Inequalities in Diabetic Foot Disease and Diabetes-Related Lower Extremity Amputations

Singh¹

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Geographic and social factors are related to increased morbidity and mortality rates in diabetic patients

Abstract: Environmental factors affect diabetes outcomes; increased morbidity and mortality rates in diabetic patients are related to socio-economic and ethnic status.

Cited by 81 publications

References 19 publications

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

Socio-Economic, Geographic, and Aboriginal and Torres Strait Islander Inequalities in Diabetic Foot Disease and Diabetes-Related Lower Extremity Amputations

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