Contribution of income to self-management and health outcomes in pediatric type 1 diabetes

Abstract

Low income has been established as a risk factor for poorer outcomes in youth with type 1 diabetes; however, the effect of moderate income has not been studied. The purpose of this secondary analysis of baseline data from a multi-site study was to compare glycemic control, self-management, and psychosocial outcomes [depression, stress, and quality of life (QOL)] at different income levels in adolescents with type 1 diabetes. Youth (n = 320, mean age = 12.3 + 1.1, 55% female, 64% white, mean A1C = 8.3 ± 1.4) completed established self-management and psychosocial measures. A1C levels were collected from medical records. Caregivers reported annual family income, categorized as high (>$80K), moderate ($40–80K), or low (<$40K). Youth from high-income families had significantly lower A1C (mean = 7.9 ± 1.2) than those from the moderate-income group (8.6 ± 1.7, p < 0.001) or the low-income group (mean A1C = 8.6 ± 1.5, p = 0.003). Youth from the high-income group reported significantly better diabetes problem solving and more self-management goals than those from the moderate- or low-income groups (both p < 0.01). Youth from the high-income group also reported significantly fewer symptoms of depression, lower levels of perceived stress, and better QOL than those in the moderate or low-income groups (all p < 0.05). Multivariate linear regression models were used to test psychological and behavioral predictors of A1C and QOL. Parents’ education status (p < 0.05) and self-management activities (p < 0.01) were significant predictors of hemoglobin A1c, while income (p < 0.01) and self-management activities (p < 0.05) were significant predictors of QOL.

General and diabetes-specific stress in adolescents with type 1 diabetes

“…This finding is consistent with previous studies which have demonstrated that low-income is a risk factor for poorer outcomes in adolescents with T1D and that adolescents from low-income families report greater general stress levels than their peers from higher income families [14,22,32]. We also found that adolescents from racially diverse backgrounds reported both higher general stress and diabetes-specific stress than their Caucasian peers.…”

Impact of neighbourhood‐level inequity on paediatric diabetes care

“…Our analysis demonstrated that NEI was a significant predictor of HbA 1c , contributing to the body of evidence surrounding the impact of community‐level inequity and the social determinants of health on the clinical outcomes of individuals living with chronic diseases . These findings are also consistent with trends reported in studies that investigated the impacts of individual‐level factors such as income , socio‐economic status , and parental education/literacy on paediatric Type 1 diabetes management.…”

Factors associated with glycemic control in children and adolescents with type 1 diabetes mellitus at a tertiary-care center in Thailand: a retrospective observational study

“…Wu et al [27] found that higher levels of caregiver support during adolescence were a protective factor from the expected decline in diabetes self-management adherence. Rechenberg et al [28] showed that socioeconomic status was associated with diabetes outcomes in adolescents with T1D. Those in higher income groups reported significantly lower HbA 1c , better diabetes problem-solving, lower levels of stress, and better QoL.…”