Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study

Willers, Carl; Iderberg, Hanna; Axelsen, Mette; Dahlström, Tobias; Julin, Bettina; Leksell, Janeth; Lindberg, Agneta; Lindgren, Peter; Muth, Karin Looström; Svensson, Ann‐Marie; Lilja, Mikael

doi:10.1371/journal.pone.0199170

Cited by 18 publications

(24 citation statements)

References 18 publications

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“…Our finding of higher HbA1c levels among younger age groups have similarly been reported in earlier registry reports. 11,19,20 One of the unique elements in this registry is that each endocrinologist receives a quarterly report outlining their patient populations' achievements in metabolic outcomes, expressed both as means and as centile ranking within the group, along with the proportion using evidence-based cardiovascular disease prevention therapies. In other jurisdictions, 21 quality improvement initiatives have similarly involved outcomes reporting for pediatric T1D populations.…”

Section: Discussionmentioning

confidence: 99%

The Canadian LMC Diabetes Registry: A Profile of the Demographics, Management, and Outcomes of Individuals with Type 1 Diabetes

Aronson

Brown

Abitbol

et al. 2021

Diabetes Technology & Therapeutics

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Objective: Clinical guidelines now define the standard of diabetes care, but few health care jurisdictions systematically assess their practicality and impact. The Canadian LMC Diabetes Registry includes the electronic health records of >50 endocrinologists in three provinces and provides quarterly real-time outcome reports to each endocrinologist. This retrospective cohort study aimed to characterize the demographics, treatment regimens, and outcomes of the type 1 diabetes (T1D) patient population in the registry. Research Design and Methods: Adults were included if they had a clinical diagnosis of T1D, had seen an LMC endocrinologist between July 1, 2015 and June 30, 2018, and had follow-up >6 months. This study is registered on clinicaltrials.gov (NCT04162067). Results: The resulting cohort included 3600 individuals with mean age of 43.9-15.3 years and duration of diabetes of 21.5-13.9 years. Mean hemoglobin A1C (HbA1c) was 8.1%-1.5% and only 22.5% had achieved HbA1c £7.0%. In each measure, individuals in younger cohorts showed poorer glycemic control than older cohorts. Within each age cohort, insulin pump users showed a lower mean HbA1c than those using multiple daily injections, especially in cohorts who were also not using a continuous glucose monitor. Overall, 63.1% reported at least weekly hypoglycemia, whereas 3.6% reported severe hypoglycemia ‡1 per year. Conclusions: Despite receiving care in an advanced well-resourced environment, within a public health care system, from specialists armed with regular patient outcomes feedback, most individuals with T1D are unable to achieve the goals recommended by clinical practice guidelines.

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Section: Discussionmentioning

confidence: 99%

The Canadian LMC Diabetes Registry: A Profile of the Demographics, Management, and Outcomes of Individuals with Type 1 Diabetes

Aronson

Brown

Abitbol

et al. 2021

Diabetes Technology & Therapeutics

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“…As a result of the use of thiazolidinediones, the risk of bone fractures in postmenopausal women increases [ 15 ]. Finally, recent studies have observed a marked influence of socioeconomic and psychosocial aspects on glycemic health control and a significant association between sociodemographic profile and absolute control of T1DM risk factors [ 59 , 60 ]. Furthermore, T2DM women and men with lower income and education level show poor food choice revealing higher carbohydrate and lower fat intake.…”

Section: Sex Hormones In Endocrine Gender-related Differencesmentioning

confidence: 99%

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

Lauretta

Sansone

et al. 2018

International Journal of Endocrinology

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Gender- and sex- related differences represent a new frontier towards patient-tailored medicine, taking into account that theoretically every medical specialty can be influenced by both of them. Sex hormones define the differences between males and females, and the different endocrine environment promoted by estrogens, progesterone, testosterone, and their precursors might influence both human physiology and pathophysiology. With the term Gender we refer, instead, to behaviors, roles, expectations, and activities carried out by the individual in society. In other words, “gender” refers to a sociocultural sphere of the individual, whereas “sex” only defines the biological sex. In the last decade, increasing attention has been paid to understand the influence that gender can have on both the human physiology and pathogenesis of diseases. Even the clinical response to therapy may be influenced by sex hormones and gender, but further research is needed to investigate and clarify how they can affect the human pathophysiology. The path to a tailored medicine in which every patient is able to receive early diagnosis, risk assessments, and optimal treatments cannot exclude the importance of gender. In this review, we have focused our attention on the involvement of sex hormones and gender on different endocrine diseases.

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“…The incidence of type 1 diabetes (T1D) has been increasing in Europe and worldwide. The care of patients with T1D has a major economic impact on families and health care systems . The introduction of new technologies enables T1D patients to achieve optimal glycemic control without an increased risk of severe hypoglycemia.…”

Section: Introductionmentioning

confidence: 99%

“…The care of patients with T1D has a major economic impact on families and health care systems. 1 The introduction of new technologies enables T1D patients to achieve optimal glycemic control without an increased risk of severe hypoglycemia. However, not all modern technologies are currently covered even in developed countries, and their accessibility for children with T1D can therefore be considerably limited by the socioeconomic status of the family, type of health insurance of the patient, structure of the health system, This study aimed to evaluate the current situation of reimbursement of insulins, glucometers, insulin pumps (CSII), and continuous glucose monitoring (CGM) devices for children with T1D in European countries participating in the SWEET Project and to compare data from EU countries with the data from our previous study in 2009.…”

Section: Introductionmentioning

confidence: 99%

“…To make our study as comprehensive as possible, we approached pediatric diabetologists from five European countries without a SWEET center (Estonia, Finland, Norway, Slovakia, and Switzerland) on a collegial basis. In total, we acquired data from 29 European countries.This status of diabetes technology reimbursement in Europe was compared with that from our previous study, which reflected the situation in 27 EU member states in November 2009 1,2. In contrast to these data, we added three non-EU European countries (Switzerland, Norway, and Serbia) and Croatia (EU member since 2013).…”

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confidence: 99%

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Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: The SWEET perspective

et al. 2019

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Background Frequent use of modern diabetes technologies increases the chance for optimal type 1 diabetes (T1D) control. Limited reimbursement influences the access of patients with T1D to these modalities and could worsen their prognosis. We aimed to describe the situation of reimbursement for insulins, glucometers, insulin pumps (CSII) and continuous glucose monitoring (CGM) for children with T1D in European countries participating in the SWEET Project and to compare data from EU countries with data from our previous study in 2009. Methods The study was conducted between March 2017 and August 2017. First, we approached diabetes technology companies with a survey to map the reimbursement of insulins and diabetic devices. The data collected from these companies were then validated by members of the SWEET consortium. Results We collected data from 29 European countries, whereas all types of insulins are mostly fully covered, heterogeneity was observed regarding the reimbursement of strips for glucometers (from 90 strips/month to no limit). CSII is readily available in 20 of 29 countries. Seven countries reported significant quota issues or obstacles for CSII prescription, and two countries had no CSII reimbursement. CGM is at least partially reimbursed in 17 of 29 countries. The comparison with the 2009 study showed an increasing availability of CSII and CGM across the EU. Conclusions Although innovative diabetes technology is available, a large proportion of children with T1D still do not benefit from it due to its limited reimbursement.

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Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study

Cited by 18 publications

References 18 publications

The Canadian LMC Diabetes Registry: A Profile of the Demographics, Management, and Outcomes of Individuals with Type 1 Diabetes

The Canadian LMC Diabetes Registry: A Profile of the Demographics, Management, and Outcomes of Individuals with Type 1 Diabetes

Gender in Endocrine Diseases: Role of Sex Gonadal Hormones

Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: The SWEET perspective

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