A socioeconomic and behavioral survey of patients with difficult-to-control type 2 diabetes mellitus reveals an association between diabetic retinopathy and educational attainment

Abstract

BackgroundWe have recently reported that the attitude of patients toward risk could be a factor in the progression of diabetic complications. In general, risk preference is closely related to socioeconomic status (SES), which includes factors such as age, sex, income, and educational attainment.ObjectiveWe aimed to determine the effect of SES and behavioral propensity on the progress of diabetic complications in patients with type 2 diabetes mellitus (T2DM).MethodsWe conducted a survey of 238 patients with difficult-to-control T2DM treated at a hospital in Japan using a modified behavioral economics questionnaire that included questions related to SES. The patients had been referred by general practitioners or other departments in the hospital because of poor metabolic control or unstable complications.ResultsEducational attainment was significantly associated with progression of retinopathy in patients <65 years of age. Educational attainment of a high school diploma (12 years of education) or lower was a significant risk factor, but there were no differences among levels of attainment beyond high school (13–16 years or more of education). Behavioral propensities were also weakly associated with complications, but not as much as educational attainment. Personal income level and economic status did not show an association with the retinopathy levels.ConclusionLower educational attainment is a strong risk factor for diabetic retinopathy, and it is independent of the economic status. The result suggests that cognitive function may play an important role in the progression of diabetic retinopathy in patients with T2DM.

Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study

“…Our finding that educational attainment was not shown to be associated with achieving glycaemic targets despite the strong association seen for IRSD highlights the complexity of studying the concept of SES and its relationship with chronic disease parameters. Our finding is in contrast to international studies suggesting that socioeconomic advantage measured at the individual level such as higher educational attainment [ 22 – 25 ], higher income [ 26 , 27 ] and higher residential stability [ 28 ], were associated with a greater likelihood of achieving HbA1c targets. However, there are many different measures and ways of defining SES, a concept that is made up of individual characteristics (e.g.…”

Social Cultural and Economic Factors Affecting the Practice of Secondary Prevention among Patients with Type 2 Diabetes Mellitus at Consolata Nkubu and Meru Level Five Hospital in Meru County

“…Similar findings were shown in a study in Thailand, where patients with low socio economic status were associated with complications of diabetes mellitus [20]. However, the patient individual income was found not to determine the diabetic complications in China where there was no association between patient's economic status and development of diabetic complications [21].…”

Determinants of diabetic retinopathy in Southwest Ethiopia: a facility-based case-control study

“…Studies conducted in Saudi Arabia [25], Korea [26] and Sudan [18] suggest that less educated or who had no formal education had a high probability of developing DR than who attained higher classes. Another finding from Tokyo suggests that lack of proper educational attainment was significantly associated with the progression of retinopathy [27]. The study done in Korean population revealed that illiterate patients had a high probability of developing diabetic complications like DR [28].…”