Socioeconomic factors linked to poor glycemic control in type 1 diabetes
medwireNews: Socioeconomic deprivation, smoking, and not using flash glucose monitoring or an insulin pump are all factors associated with a decreased likelihood of achieving glycated hemoglobin (HbA1c) targets in type 1 diabetes, research shows.
Fraser Gibb (University of Edinburgh, UK) and co-investigators say: “Achieving HbA1c targets remains confined to [the] minority of individuals with type 1 diabetes in Scotland, with the likelihood of meeting targets strongly associated with a range of factors including technology use, cigarette smoking, socioeconomic deprivation and extent of endogenous insulin secretion.”
They add: “Addressing disparities in outcome will require treatments which are effective irrespective of socioeconomic deprivation status and ensuring wider access to existing effective therapies.”
Their findings are based on a cross‐sectional analysis of 4594 individuals (median age 46 years, 55% men) with type 1 diabetes who attended a clinic at a single center in Scotland between May 2018 and May 2020.
Of these, 30% had an HbA1c level below the Scottish target of 58 mmol/mol (7.5%) and 9.3% met the UK National Institute for Health and Care Excellence (NICE) target of 48 mmol/mol (6.5%) or lower.
The researchers report in Diabetic Medicine that never smoking (odds ratio [OR]=2.88 vs ever smoking), prior smoking (OR=1.97 vs current smoking), use of flash glucose monitoring (OR=1.56), being in the most affluent quintile of socioeconomic deprivation (OR=1.56), using an insulin pump (OR=1.41), and male sex (OR=1.35) were all significantly associated with an increased likelihood for achieving the Scottish HbA1c target, after adjustment for potential confounders.
Conversely, obesity (OR=0.76) was associated with a significantly lower likelihood of meeting this target.
Similar results were observed when using the NICE target for HbA1c, with the exception of flash monitoring and insulin pump use, which were no longer associated with meeting glycemic control targets.
The results were also broadly similar when the analysis was restricted to the 1592 participants with C-peptide data, but in this case increasing age (OR=0.99 per year) and having a C‐peptide level below 50 pM (OR=0.58) were associated with a significantly lower likelihood of meeting the Scottish target.
Additional analyses revealed that female sex, younger age, longer diabetes duration, and never smoking were all independently associated with both having a C-peptide below 50 pM and insulin pump use. Having a lower level of deprivation and attending a diabetes education course were also associated with an increased likelihood for insulin pump use.
Gibb and co-authors conclude: “Inequalities in access to technology and structured education follow a clear gradient of socioeconomic deprivation and efforts should be focused on the introduction of therapies which achieve the greatest reduction of HbA1c with the minimum burden on the individual with diabetes.”
“The evaluation of such therapies, particularly in individuals with higher HbA1c and socioeconomic deprivation, should be a focus of research in clinical diabetes in the coming years,” they add.
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