Impact of deprivation on glycaemic control in youth with type 1 diabetes in the southwestern region of France

Abstract

Objectives The objective of this multicenter cross‐sectional study was to determine predictors of poor glycaemic control in children with type 1 diabetes mellitus (T1DM), particularly with respect to socioeconomic status (SES). Methods Our study population consisted of 1154 children who attended T1DM follow‐up consultation with a pediatric diabetes specialist. Clinical and demographic data were retrieved retrospectively from patients' records. Individual deprivation was defined by an EPICES (Evaluation of the Deprivation and Inequalities of Health in Healthcare Centers) score ≥ 30. Patients were assigned to quintiles of the European Deprivation Index (EDI) based on their area deprivation scores. We used multivariable linear regression models to detect potential associations between glycaemic control and indicators of low SES. Results In total, 33% (n = 376) of patients had an EPICES score ≥ 30 and 23% (n = 268) were in the 5th EDI quintile. Multivariable linear regression analysis showed that poor glycaemic control was associated with both individual (β 0.38; 95%CI 0.26–0.5; p < 0.001) and area deprivation (β 0.26; 95%CI 0.08–0.43; p = 0.004). Demographic factors, body mass index (BMI) and insulin regimen were also independently associated with poor glycaemic control (p < 0.001). Interestingly, access to diabetes technologies was not related to SES or either glycaemic control. Conclusion Low SES is associated with a higher risk of poor glycaemic control, independently of insulin regimen. BMI, age at the time of consultation, duration of diabetes, and insulin regimen. Also have an impact on HbA1c. These parameters need to be considered when developing novel treatment strategies for children with T1DM to better target at‐risk patients.

Associations of Area-Level and Parental Individual-Level Social Deprivation with Glycemic Control over Time among Children with Type 1 Diabetes in France: A Longitudinal Cohort Study

“…Alternatively, the current study may have lacked adequate statistical power, or the follow-up time may have been insufficient. Similar to our findings, some studies showed that area-level deprivation was associated with long-term HbA1c levels [6,8,9,11]. The French study cited above revealed a significant association between HbA1c levels and the EDI quintiles, but the EDI did not reflect glycemic control in a manner consistent with the EPICES score [11].…”

“…Several studies have shown that individual social deprivation is associated with longer-term glycemic control [2][3][4][5]11]. One French study showed that the mean HbA1c level measured at follow-up visits > 1 year after T1D diagnosis was 43% higher in children/adolescents with EPICES scores ≥ 30.17, compared with children/adolescents who had lower scores (P <0:001) [11]. However, we found no association between the EPICES score and the HbA1c trajectory > 4 months after diagnosis.…”

“…Only a few studies have used both individual and ecological indicators to assess social deprivation. In France, there are limited data regarding social inequalities in childhood, as well as the effects of inequalities on T1D; further research is needed to guide new management strategies [11,12]. The primary objective of this study was to determine the association between the HbA1c trajectory and social deprivation in children who were newly diagnosed with T1D.…”

The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review

“…A study running from 2017 to 2018 found no association of deprivation with CGM utilization, concluded to be due to the pervasiveness of the health insurance system. 46 …”

“…In Germany, France, and Australia, the inclusion of CGMs in universal healthcare plans correlated with large increases in usage, predominantly among those of lower SES. 34 , 44 , 46 In California, generous is-CGM reimbursement practices for their Medicaid recipients impacted disparities to such a degree that no significant differences in CGM utilization were found among the various ethnicities. 66 …”