Socioeconomic deprivation and cardiometabolic risk factors in individuals with type 1 diabetes: T1D exchange clinic registry

Griggs, Stephanie; Al‐Kindi, Sadeer G.; Hardin, Heather K.; Irani, Elliane; Rajagopalan, Sanjay; Crawford, Sybil L.; Hickman, Ronald L.

doi:10.1016/j.diabres.2022.110198

Cited by 2 publications

(3 citation statements)

References 45 publications

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“…Although an association between T2D development and SES [ 23 , 24 ] has been previously reported, this relation has not been observed for T1D [ 25 ], probably due to its different pathophysiology. However, in patients with T1D maintaining a good chronic control [ 6 , 26 , 27 ], the risk of complications [ 8 , 9 , 28 ], and even mortality [ 10 , 11 ] are associated with the SES of individuals. The reasons behind these disparities in glycemic control in people with T1D showing different SES remain to be determined.…”

Section: Discussionmentioning

confidence: 99%

Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study

Sebastian-Valles,

Martínez-Alfonso,

Arranz Martin

et al. 2024

BMC Med

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Background This study investigates the association between socioeconomic status (SES) and glycemic control in individuals with type 1 diabetes (T1D) using flash glucose monitoring (FGM) devices within a public health system where these technologies are freely available and utilized according to recommended guidelines. Methods A follow-up study of 1060 adults (mean age 47.4 ± 15.0 years, 49.0% women) with T1D, receiving care at three Spanish university hospitals that regularly employ the FGM system. SES was assessed using the Spanish Deprivation Index and the average annual net income per person. Glycemic data were collected over a 14-day follow-up period, including baseline glycated hemoglobin (HbA1c) levels prior to sensor placement, the last available HbA1c levels, and FGM-derived glucose metrics. Individuals with sensor usage time < 70% were excluded. Chronic micro and macrovascular complications related to diabetes were documented. Regression models, adjusted for clinical variables, were employed to determine the impact of SES on optimal sensor control (defined as time in range (TIR) ≥ 70% with time below range < 4%) and disease complications. Results The average follow-up was of 2 years. The mean TIR and the percentage of individuals with optimal control were higher in individuals in the highest SES quartile (64.9% ± 17.8% and 27.9%, respectively) compared to those in the lowest SES quartile (57.8 ± 17.4% and 12.1%) (p < 0.001). Regression models showed a higher risk of suboptimal control (OR 2.27, p < 0.001) and ischemic heart disease and/or stroke (OR 3.59, p = 0.005) in the lowest SES quartile. No association was observed between SES and the risk of diabetic nephropathy and retinopathy. FGM system improved HbA1c levels across all SES quartiles. Although individuals in the highest SES quartile still achieved a significantly lower value at the end of the follow-up 55 mmol/mol (7.2%) compared to those in the lowest SES quartile 60 mmol/mol (7.6%) (p < 0.001), the significant disparities in this parameter between the various SES groups were significantly reduced after FGM technology use. Conclusions Socioeconomic status plays a significant role in glycemic control and complications in individuals with T1D, extending beyond access to technology and its proper utilization. The free utilization of FGM technology helps alleviate the impact of social inequalities on glycemic control.

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Section: Discussionmentioning

confidence: 99%

Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study

Sebastian-Valles,

Martínez-Alfonso,

Arranz Martin

et al. 2024

BMC Med

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show abstract

“…9,[11][12][13][14] Targets for cardiometabolic risk factors are less often met, and life expectancy and years spent without complications are lower than in those living without diabetes. 15,16 In the Netherlands, most studies related to SES and diabetes focus on type 2 diabetes. It is known that people with diabetes more often have low SES than high SES.…”

Section: Introductionmentioning

confidence: 99%

“…Use of diabetes technology, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM), is, apart from reimbursement policies, also influenced by SES‐related factors at all ages 9,11–14 . Targets for cardiometabolic risk factors are less often met, and life expectancy and years spent without complications are lower than in those living without diabetes 15,16 . In the Netherlands, most studies related to SES and diabetes focus on type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

Socio‐economic disparities in hospital care among Dutch patients with diabetes mellitus

de Vries,

Sas,

Bak

et al. 2024

Diabetes Obesity Metabolism

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AimSocio‐economic status (SES) influences diabetes onset, progression and treatment. In this study, the associations between SES and use of hospital care were assessed, focusing on hospitalizations, technology and cardiovascular complications.Materials and MethodsThis was an observational cohort study comprising 196 695 patients with diabetes (all types and ages) treated in 65 hospitals across the Netherlands from 2019 to 2020 using reimbursement data. Patients were stratified in low, middle, or high SES based on residential areas derived from four‐digit zip codes.ResultsChildren and adults with low SES were hospitalized more often than patients with middle or high SES (children: 22%, 19% and 15%, respectively; p < .001, adults: 28%, 25% and 23%; p < .001). Patients with low SES used the least technology: no technology in 48% of children with low SES versus 40% with middle SES and 38% with high SES. In children, continuous subcutaneous insulin infusion (CSII) and real‐time continuous glucose monitoring (rtCGM) use was higher in high SES {CSII: odds ratio (OR) 1.54 [95% confidence interval (CI) 1.35‐1.76]; p < .001; rtCGM OR 1.39 [95% CI 1.20‐1.61]; p < .001} and middle SES [CSII: OR 1.41 (95% CI 1.24‐1.62); p < .001; rtCGM: OR 1.27 (95% CI 1.09‐1.47); p = .002] compared with low SES. Macrovascular (OR 0.78 (95% CI 0.75‐0.80); p < .001) and microvascular complications [OR 0.95 (95% CI 0.93‐0.98); p < .001] occurred less in high than in low SES.ConclusionsSocio‐economic disparities were observed in patients with diabetes treated in Dutch hospitals, where basic health care is covered. Patients with low SES were hospitalized more often, used less technology, and adults with high SES showed fewer cardiovascular complications. These inequities warrant attention to guarantee equal outcomes for all.

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Socioeconomic deprivation and cardiometabolic risk factors in individuals with type 1 diabetes: T1D exchange clinic registry

Cited by 2 publications

References 45 publications

Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study

Impact of socioeconomic status on chronic control and complications of type 1 diabetes mellitus in users of glucose flash systems: a follow-up study

Socio‐economic disparities in hospital care among Dutch patients with diabetes mellitus

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