The association between sociodemographic and clinical characteristics and poor glycaemic control: a longitudinal cohort study

McBrien, Kerry; Manns, Braden; Hemmelgarn, Brenda R.; Weaver, R. W.; Edwards, Alun; Ivers, Noah; Rabi, Doreen M.; Lewanczuk, Richard; Braun, Theodore E. D.; Naugler, Christopher; Campbell, David; Saad, Nathalie; Tonelli, Marcello

doi:10.1111/dme.13023

Cited by 20 publications

(20 citation statements)

References 21 publications

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“…Other studies of adults with T1DM have found that glycemic control tends to improve with increasing age. 17,22–24 Episodes of severe hypoglycemia were more common among older people in the current study, a finding that has been reported previously. 17,22 DKA was less common with increasing age, which has also been reported previously.…”

Section: Discussionsupporting

confidence: 90%

Patient and disease characteristics of adult patients with type 1 diabetes in Germany: an analysis of the DPV and DIVE databases

Mark

Lanzinger

Barion

et al. 2019

Therapeutic Advances in Endocrinology

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Background: An understanding of the current status of patients with type 1 diabetes mellitus (T1DM) can help to provide appropriate treatment. Methods: This was a retrospective analysis of the DIabetes Versorgungs-Evaluation (DIVE) and the Diabetes-Patienten-Verlaufsdokumentation (DPV) databases for Germany. Results: The analysis included 56,250 people with T1DM (54.2% male), a median age of 36.8 years, and a median diabetes duration of 12.4 years. 15.3% were obese (body mass index ≥ 30kg/m 2 ). Long-acting insulin analogs were used by 53.3%, short-acting analogs by 72.1%, and oral antidiabetic drugs by 4.7%. Patients had a median glycosylated hemoglobin (HbA1c) of 7.8%. There was a drop in HbA1c and an increase in the rate of hypertension, oral antidiabetic drug use, and in the rate of severe hypoglycemia (all p < 0.01) with age. Flash glucose monitoring (FGM) showed the best glucose values with fewer complications compared to other monitoring systems. HbA1c and FBG were lower in patients using a pump versus multiple daily injections (MDIs; 7.7 versus 7.9% and 7.8 versus 8.7 mmol/l; all adjusted p < 0.01). Patients had a lower risk of at least one severe hypoglycemic or DKA episode during the most recent treatment year with pump treatment compared to MDI (9.4% versus 10.5% and 4.7% versus 6.1%, both adjusted p < 0.01). Conclusion: The data demonstrated less-than-optimal glycemic control in the young, an increasing metabolic pattern in T1DM with increasing age, a benefit of FGM to improve HbA1c control and adverse effects, as well as benefits of pump treatment over MDIs.

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Section: Discussionsupporting

confidence: 90%

Patient and disease characteristics of adult patients with type 1 diabetes in Germany: an analysis of the DPV and DIVE databases

Mark

Lanzinger

Barion

et al. 2019

Therapeutic Advances in Endocrinology

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“…Similar to studies conducted in the Arabian Gulf [ 49 , 50 ] and other countries [ 18 , 51 ] we found that younger age groups (≤60 years) were at higher risk of inadequate glycaemic control. Younger people are more likely to be affected by the change in lifestyle and less likely to be adherent to a management plan because of active occupational and social life [ 52 ].…”

Section: Discussionsupporting

confidence: 90%

Glycaemic control for people with type 2 diabetes in Saudi Arabia – an urgent need for a review of management plan

et al. 2018

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BackgroundThe aim of this study was to assess inadequate glycaemic control and its associated factors among people with type 2 diabetes in Saudi Arabia.MethodsA cross-sectional study design was used. Adults with type 2 diabetes attending diabetes centres in Riyadh, Hofuf and Jeddah cities were interviewed and their anthropometrics were measured. Their medical records were also reviewed to collect information related to recent lab tests, medications, and documented comorbidities. Multivariable logistic regression were used for data analysis.ResultsA total of 1111 participants were recruited in the study. Mean age was 57.6 (±11.1) years, 65.2% of the participants were females, and mean HbA1c was 8.5 ± 1.9%. About three-fourths of participants had inadequate glycaemic control (≥ 7%). Multivariable analysis showed that age ≤ 60 years, longer duration of diabetes, living in a remote location, low household income, low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, low adherence to medication, and using injectable medications were independent risk factors for inadequate glycaemic control.ConclusionsInadequate glycaemic control is prevalent among people with type 2 diabetes in Saudi Arabia. In order to improve glycaemic control diabetes management plan should aim at controlling the modifiable risk factors which include low intake of fruits and vegetable, low level of physical activity, lack of knowledge about haemoglobin A1c, high waist-hip ratio, and low adherence to medications.

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“…In this population‐based study of individuals with diabetes, we found that lower income and lower age were associated with higher HbA 1c levels. This occurred despite the publicly funded healthcare system in Ontario that covers hospital and physician services for all residents, and corroborates previously published findings from Alberta . Disparities in glycaemic control across income groups were more pronounced for individuals aged <65 years, who are not eligible for universal drug insurance and who must often rely on private insurance or pay out‐of‐pocket for their prescription drugs.…”

Section: Discussionsupporting

confidence: 84%

“…However, these gradients are significantly diminished at age 65 years when residents gain access to prescription drug coverage. In a study examining predictors of sustained poor glycaemic control, socio‐economic gradients were attenuated in those aged ≥66 years . In the USA, the implementation of Medicare Part D drug coverage was associated with improvements in drug utilization and reductions in cost‐related non‐adherence and out‐of‐pocket costs in seniors, especially for those who previously had no drug insurance or had only limited benefits through Medigap .…”

Section: Discussionmentioning

confidence: 99%

Universal drug coverage and income‐related disparities in glycaemic control

2019

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Aims To examine whether income-related disparities in glycaemic control decline after the age of 65 years, when publicly funded universal drug insurance is acquired in Ontario, Canada. MethodsWe conducted a population-based cross-sectional study using linked administrative healthcare databases. Adults with diabetes, aged 40-89 years, with available HbA 1c data were included (N = 716 297). Income was based on median neighbourhood household income. Multiple linear regression was used to test for effect modification of age ≥65 years on the relationship between income and HbA 1c .Results There was a significant inverse association between income and HbA 1c level. After adjusting for baseline factors, the effect of income on HbA 1c level was significantly greater for individuals aged <65 years (mean difference HbA 1c for lowest vs highest income group +2.5 mmol/mol, 95% CI +2.3 to +2.7 [+0.23%, 95% CI 0.21 to 0.24]) than for those aged ≥65 years (+1.2 mmol/mol, 95% CI +1.0 to +1.3 [+0.11%, 95% CI 0.10 to 0.12]; P < 0.0001 for interaction).Conclusions Despite universal access to healthcare, people with diabetes with lower incomes had significantly worse glycaemic control compared with their counterparts on higher incomes. However, income gradients in glycaemic control were markedly reduced after the age of 65 years, possibly as a result of access to prescription drug coverage.

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The association between sociodemographic and clinical characteristics and poor glycaemic control: a longitudinal cohort study

Cited by 20 publications

References 21 publications

Patient and disease characteristics of adult patients with type 1 diabetes in Germany: an analysis of the DPV and DIVE databases

Patient and disease characteristics of adult patients with type 1 diabetes in Germany: an analysis of the DPV and DIVE databases

Glycaemic control for people with type 2 diabetes in Saudi Arabia – an urgent need for a review of management plan

Universal drug coverage and income‐related disparities in glycaemic control

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