Socio‐economic status and HbA_1c in type 2 diabetes: A systematic review and meta‐analysis

Abstract

Up until now, differences in HbA levels by socio-economic status (SES) have been identified, but not yet quantified in people with type 2 diabetes. The aim of this study was therefore to assess the difference in HbA levels between people with type 2 diabetes of different SES in a systematic review and meta-analysis. A systematic literature search was conducted in MEDLINE, Embase, Ebsco, and the Cochrane Library until January 14, 2018. Included studies described adults with type 2 diabetes in whom the association between SES and HbA levels was studied. Studies were rated for methodological quality and data were synthesized quantitatively (meta-analysis) and qualitatively (levels of evidence), stratified for type of SES variable, i.e., education, income, deprivation, and employment. Fifty-one studies were included: 15 high, 27 moderate, and 9 of low methodological quality. Strong evidence was provided that people of low SES have higher HbA levels than people of high SES, for deprivation, education, and employment status. The pooled mean difference in HbA levels between people of low and high SES was 0.26% (95% CI, 0.09-0.43) or 3.12 mmol/mol (95% CI, 1.21-5.04) for education and 0.20% (95% CI, -0.05 to 0.46) or 2.36 mmol/mol (95%CI, -0.61 to 5.33) for income. In conclusion, our systematic review and meta-analysis showed that there was an inverse association between SES and HbA levels in people with type 2 diabetes. Future research should focus on finding SES-sensitive strategies to reduce HbA levels in people with type 2 diabetes.

New research directions on disparities in obesity and type 2 diabetes

“…Lower SES has historically been associated with worse glycemic control among adults with type 2 diabetes, particularly younger adults. 14,15 Quality of diabetes care and preventive care practices to forestall diabetes-related complications vary according to disparities in access to care. 16 For example, even among insured populations, Latinos are less likely to receive regular care and less likely to meet HbA1c targets.…”

A systematic review of factors associated with uncontrolled diabetes and meta‐analysis of its prevalence in Saudi Arabia since 2006

“…On the other hand, inconsistent predictors of high HbA 1c were age, gender, education, employment status, depression, smoking, physical activity, and BMI. While these variables are known to be strong predictors of HbA 1c , 46,47 almost none of the studies provided any explanation as to why age and gender, as examples, were not statistically significant. This was presumably due to the low quality of evidence; the highest proportion of the studies found age and gender not to be related to HbA 1c .…”

Predictors of Glycemic Control among Patients with Type 2 Diabetes in Western China: A Multi-center Cross Sectional Study

“…A cross-sectional survey performed in France concluded that people with diabetes reporting financial difficulties were more likely to have poorer glycemic control. 25) The Systematic review also showed that people with lower socioeconomic status had higher HbA1c levels. 26) Therefore, our findings between economic situation and glycemic control were inconsistent with the previous study.…”

“…25) The Systematic review also showed that people with lower socioeconomic status had higher HbA1c levels. 26) Therefore, our findings between economic situation and glycemic control were inconsistent with the previous study. This discrepancy may be the result of uneven distribution of medical resources and different emphasis on medical management.…”