Impact of Socioeconomic Status on Health Behaviors, Metabolic Control, and Chronic Complications in Type 2 Diabetes Mellitus

Abstract

BackgroundThe aim of the study was to assess the impact of socioeconomic status (SES) on health behaviors, metabolic control, and chronic complications in people with type 2 diabetes mellitus (T2DM) from South Korea, a country with universal health insurance coverage and that has experienced rapid economic and social transition.MethodsA total of 3,294 Korean men and women with T2DM aged 30 to 65 years, participating in the Korean National Diabetes Program (KNDP) cohort who reported their SES and had baseline clinical evaluation were included in the current cross-sectional analysis. SES included the level of education and monthly household income.ResultsLower education level and lower income level were closely related, and both were associated with older age in men and women. Women and men with lower income and education level had higher carbohydrate and lower fat intake. After adjustment for possible confounding factors, higher education in men significantly lowered the odds of having uncontrolled hyperglycemia (glycosylated hemoglobin ≥7.5%) (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.43 to 0.91 for highest education; Ptrend=0.048), while higher household income in men significantly lowered the odds of having diabetic retinopathy (OR, 0.59; 95% CI, 0.37 to 0.95 for highest income level; Ptrend=0.048). In women, lower income was associated with a higher stress level.ConclusionMen with lower SES had higher odds of having diabetic retinopathy and uncontrolled hyperglycemia, showing the need to improve care targeted to this population.

Diabetes Fact Sheets in Korea, 2018: An Appraisal of Current Status

“…Previous studies have shown that people with low socioeconomic status (SES) were more likely to develop type 2 diabetes with worse glycemic control that can lead to more diabetic complications [1314]. According to the Korean National Diabetes Program (KNDP) cohort study, men with low SES had worse glycemic control and higher risk for retinopathy [15]. In addition, in Korea, low-income people with diabetes had lower medication adherence and lower levels of utilization of fundus examinations and HbA1c tests than high-income people with diabetes [16].…”

Dietary Habits and Dietary Antioxidant Intake Are Related to Socioeconomic Status in Polish Adults: A Nationwide Study

“…This finding is consistent with the results of other studies. It is well-documented that a low socioeconomic status (education level and income) has a significant impact on the incidence of obesity, diabetes, and cardiovascular disease [27][28][29]. In the cross-sectional EUROASPIRE IV study, which was undertaken in 24 European countries, a higher level of education was found to have a significant impact on the control of risk factors in patients with coronary heart disease, such as currently smoking, being overweight, obesity, a low level of physical activity, low HDL-C, hypertension, and diabetes [30].…”

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

“…Furthermore, T2DM women and men with lower income and education level show poor food choice revealing higher carbohydrate and lower fat intake. Considering the sex-related difference in insulin sensitivity, it is clear how sociodemographic aspects may interact with biology [ 61 ]. This association has been observed also in pregnant woman [ 62 ].…”