Association between socioeconomic status and metabolic control and diabetes complications: a cross-sectional nationwide study in Chinese adults with type 2 diabetes mellitus

Abstract

BackgroundLow socioeconomic status (SES) is associated with adverse cardiovascular risk factor patterns and poor outcomes in patients with diabetes. The aim of this study was to determine whether SES is associated with the control of blood glucose, blood pressure, blood cholesterol (3Bs), and diabetic complications in Chinese adults with type 2 diabetes.MethodsData regarding patients’ demographics, social economics, diabetes complications, and cardiovascular risk profiles were analyzed for 25,454 patients. The outcomes of interest were the proportions of patients with HbA1c <7.0 %, blood pressure <140/80 mmHg, total serum cholesterol <4.5 mmol/L, and diabetes complications. Multivariable logistic regression was used for analysis.ResultsOf the 25,454 patients, the least educated patients (1695, 6.7 %) had the highest chances of developing cardiovascular diseases (p = 0.048), cerebrovascular diseases (p < 0.001), and retinopathy (p < 0.001). The patients with lowest household income (10,039, 40.8 %) had the highest prevalence of retinopathy (p < 0.001) and neuropathy (p < 0.001). The most educated patients were more likely than the least educated patients to achieve HbA1c <7.0 % [adjusted odds ratio (OR) 1.38; 95 % confidence interval (95 % CI) 1.22–1.56] and 3B goals (adjusted OR 1.30; 95 % CI 1.11–1.53). The patients with highest household income were more likely to achieve BP < 140/80 mmHg (adjusted OR 1.16; 95 % CI 1.07–1.27), but less likely to reach HbA1c < 7.0 % (adjusted OR 0.90; 95 % CI 0.83–0.98) than those lowest income patients.ConclusionsLow SES was associated with poor metabolic control and more diabetes complications in adult patients in China. Individual diabetes management based on the SES of patients is encouraged.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0376-7) contains supplementary material, which is available to authorized users.

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

“…Individuals of lower SES have limited income, poorer occupational opportunity, and reduced access to health care services and information. The patients with the lowest household income have been shown to have the highest prevalence of retinopathy and neuropathy 15. However, in the present study, we did not find a significant association between income level and retinopathy level.…”

Incidence and Risk Factors for Developing Diabetic Retinopathy among Youths with Type 1 or Type 2 Diabetes throughout the United States

“…Increasing risk of DR among patients who were diagnosed with T1DM at older ages has also been reported previously and postulated to be related to increased risk associated with puberty. 32 We also found that youth with T2DM from households with higher net worth had decreased development of DR, similar to previous literature on socioeconomic risk factors for DR which reported that persons of lower affluence levels were at greater risk for DR both for adults 33 and youth 34 with T2DM and T1DM. 35 This may be related to lifestyle factors such as diet, exercise, and smoking.…”

Prediabetes awareness among Southeastern European physicians

“…Furthermore, the PD treatment recommendations do not represent an object of interest in Croatian guidelines for type 2 diabetes mellitus treatment. As all of the countries that participated in this survey belong to low‐ or middle‐income European countries, a type 2 diabetes mellitus prevention strategy would decrease the economic burden of the treatment of type 2 diabetes mellitus complications.…”