Socio‐economic inequalities in glycaemic control in recently diagnosed adults with type 1 and type 2 diabetes

Abstract

Background and aims: It is unclear whether socio-economic status (SES) is associated with glycaemic control in people with recently diagnosed diabetes. The aim was to investigate whether SES is related to haemoglobin A1c (HbA1c) during the first year after diagnosis in people with type 1 and type 2 diabetes and if metabolic, quality of care or mental factors may explain the association. Methods:In the German Diabetes Study, people with type 1 (n = 274, median age 36 [25th; 75th percentile: 28; 48] years) and type 2 diabetes (n = 424, 54 [47; 60] years) underwent detailed metabolic characterisation within the first year after diagnosis. SES was documented using a standardised questionnaire. Associations between SES and HbA1c were assessed using multivariable linear regression and and the Ministry of Innovation, Science, Research and Technology of the state North Rhine-Westphalia (Düsseldorf, Germany) and from the German Federal Ministry of Education and Research (BMBF) to the German Center for Diabetes Research (DZD e.V.). The sponsors played no role in the planning, analysis or preparation of this manuscript.restricted cubic spline regression analyses. Additional covariables were patient characteristics, laboratory measurements, health behaviour, quality of care and depression variables. Models were separately fitted for diabetes type, SES and its dimensions (income, education, occupation).Results: Higher SES score was associated with lower HbA1c (−0.7 mmol/mol per unit increase in SES, 95% CI: −1.1; −0.2 mmol/mol [−0.1%, 95% CI: −0.1; 0.0%]) in people with type 1 diabetes. Included covariates did not attenuate this association. In people with type 2 diabetes, effect estimates were close to zero indicating no relevant difference. Conclusion:Socio-economic inequalities in HbA1c already exist during the first year after diagnosis in people with type 1 diabetes. The absence of association between glycaemic control and SES in type 2 diabetes could be due to the lower complexity of diabetes therapy compared to type 1 diabetes.

Psychosocial aspects and perspectives of adult‐onset type 1 diabetes: A systematic scoping review

“…The number of participants in the studies varied from seven to 274. Demographic data describing the context and the population were sparse except for one study 36 . Three studies did not report participants' gender, 37–39 and three studies did not report age of participants 37,38,40 (however, from the study descriptions it was evident the participants were adults).…”

“…In five of the 10 reports, the main aim was to explore psychosocial aspects related to adult‐onset T1D. These five studies explored: the personal experience of the T1D diagnosis 40 ; psychological distress following the diagnosis 42 ; the association between the diagnosis and developing an eating disorder 45 ; and the influence of psychosocial health on metabolic levels 36,41 …”

“…While depression was measured in four studies, four different measures to assess depression were used: Beck's depression inventory and a DSM‐10 interview, 41,42 Center for Epidemiologic Studies Depression Scale 36 and Hospital Anxiety and Depression Scale 46 . The studies used various language to describe mental outcomes: in one study, mental health was measured by Center for Epidemiologic Studies Depression Scale (CES‐D), 36 and in another, mental strain was measured by mental component of SF‐36 39 and lastly Zerssen's symptom checklist to measure mental symptoms was used in two studies 41,42 . Two intervention studies measured participants' confidence in managing their diabetes with nonvalidated questionnaires developed for these specific studies 37,38 .…”

“…These five studies explored: the personal experience of the T1D diagnosis 40 ; psychological distress following the diagnosis 42 ; the association between the diagnosis and developing an eating disorder 45 ; and the influence of psychosocial health on metabolic levels. 36,41 The remaining five studies addressed psychosocial aspects as part of the study. One study explored information needs in adults with new-onset T1D or T2D, 39 another how a T1D diagnosis affected attitudes and barriers to exercise.…”

“…The third study reported data about adults with new-onset T1D or T2D in the German Diabetes Study. 36 The study aims were to explore whether low socio-economic status (SES) was associated with increased HbA 1c and to investigate whether health behaviour, depression and quality of care were associated with HbA 1c levels and SES. SES was defined by an aggregated multidimensional score based on income, education and occupation and grouped into three categories: Low (lowest 20% of the distribution in the cohort), medium (middle 60%) and high (highest 20%).…”