Inequalities in glycaemic control, hypoglycaemia and diabetic ketoacidosis according to socio‐economic status and area‐level deprivation in Type 1 diabetes mellitus: a systematic review

Abstract

Aim The aim of this systematic review was to examine the associations of individual-level as well as area-level socioeconomic status and area-level deprivation with glycaemic control, hypoglycaemia and diabetic ketoacidosis in people with Type 1 diabetes mellitus.Methods Ovid MEDLINE was searched to identify relevant cohort, case-control or cross-sectional studies published between January 2000 and June 2015. Search results were screened by title, abstract and keywords to identify eligible publications. Decisions on inclusion or exclusion of full texts were made independently by two reviewers. The Newcastle-Ottawa Scale was used to estimate the methodological quality of included studies. Quality assessment and extracted data of included studies were synthesized narratively and reported according to the PRISMA statement.Results Literature search in Ovid MEDLINE identified 1345 eligible studies. Twenty studies matched our inclusion and exclusion criteria. Two articles were additionally identified through hand search. According to the Newcastle-Ottawa Scale, most of the studies were of average quality. Results on associations of socio-economic status and area-level deprivation with glycaemic control and hypoglycaemia were contradictory between studies. By contrast, lower socioeconomic status and higher area-level deprivation were associated with a higher risk for diabetic ketoacidosis in all except one study.Conclusions Lower socio-economic status and higher area-level deprivation are associated with a higher risk of experiencing diabetic ketoacidosis in people with Type 1 diabetes mellitus. Access to care for socially deprived people needs to be expanded to overcome impairing effects on the course of the condition and to reduce healthcare disparities.

Severe hypoglycemia and diabetic ketoacidosis in young persons with preschool onset of type 1 diabetes mellitus: An analysis of three nationwide population-based surveys

“…Lower SES and higher HbA1c levels were associated with higher rates of DKA‐related hospitalizations, which is in accordance with previous reports . A systematic review reported evidence that lower SES and higher area‐level deprivation was significantly associated with a higher frequency of DKA in the course of the disease.…”

“…A systematic review reported evidence that lower SES and higher area‐level deprivation was significantly associated with a higher frequency of DKA in the course of the disease. As explanation, a lower utilization of health services among socially deprived persons occurring even in countries with universal health care coverage such as Germany was discussed . Furthermore, higher HbA1c levels suggest poorer treatment adherence, often resulting in higher rates of hospitalization for DKA …”

Occurrence of severe hypoglycaemic events among US youth and young adults with type 1 or type 2 diabetes

“…We also found no significant association between SH and parental education or health insurance, both markers of socio‐economic status. This is consistent with the findings of a recent systematic review which found that neither health insurance nor education was consistently associated with either an increase or decrease in risk of hypoglycaemia among both children and adults with type 1 diabetes …”

Partial remission in type 1 diabetes and associated factors: Analysis based on the insulin dose‐adjusted hemoglobin A1c in children and adolescents from a regional diabetes center, Auckland, New Zealand

“…Ethnicity and socioeconomic status (SES) are well‐established and closely linked risk factors for a range of health outcomes, including inequalities in diabetes outcomes (both acute and chronic) . Determining the relative contribution of genetic and cultural influences on health vs the fundamental fiscal ability to access and use necessary health care has proved difficult.…”