Socioeconomic deprivation, technology use, C‐peptide, smoking and other predictors of glycaemic control in adults with type 1 diabetes

Dover, Anna R.; Strachan, Mark W. J.; McKnight, John; Stimson, Roland H; Mackenzie, Simon J; Lyall, Marcus J.; Wright, Rohana J.; Forbes, Shareen; Gibb, Fraser

doi:10.1111/dme.14445

Cited by 18 publications

(16 citation statements)

References 27 publications

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“…Our findings are comparable to previously published literature. [22][23][24] The greatest variation was observed with CSII use. A key reason may be the variation observed in structured education uptake; the percentage of people completing structured education in the least deprived group was almost double that of the most deprived group.…”

Section: Discussionmentioning

confidence: 99%

The impact of socio‐economic deprivation on access to diabetes technology in adults with type 1 diabetes

et al. 2022

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Background With advances in technology, there is an emerging concern that inequalities exist in provision and diabetes outcomes in areas of greater deprivation. We assess the relationship between socio‐economic status and deprivation with access to diabetes technology and their outcomes in adults with type 1 diabetes. Methods Retrospective, observational analysis of adults attending a tertiary centre, comprising three urban hospitals in the UK. Socio‐economic deprivation was assessed by the English Indices of Deprivation 2019. Data analysis was performed using one‐way ANOVAs and chi‐squared tests. Results In total, 1631 adults aged 44 ± 15 years and 758 (47%) women were included, with 391 (24%) using continuous subcutaneous insulin infusion, 312 (19%) using real‐time continuous glucose monitoring and 558 (34%) using intermittently scanned continuous glucose monitoring. The highest use of diabetes technology was in the least deprived quintile compared to the most deprived quintile (67% vs. 45%, respectively; p < 0.001). HbA1c outcomes were available in 400 participants; no association with deprivation was observed (p = 0.872). Participation in structured education was almost twice as high from the most deprived to the least deprived groups (23% vs. 43%; p < 0.001). Adults with white or mixed ethnicity were more likely to use technology compared to black ethnicity (60% vs. 40%; p < 0.001). Conclusions Adults living in the most deprived quintile had less technology use. Irrespective of socio‐economic status or ethnicity, glycaemia was positively affected in all groups. It is imperative that health disparities are further addressed.

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Section: Discussionmentioning

confidence: 99%

The impact of socio‐economic deprivation on access to diabetes technology in adults with type 1 diabetes

et al. 2022

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“…Since the first mandated social lockdowns, a series of studies have assessed the efficacy of these tools as enablers of diabetes management at a distance. These include studies in Scotland [ 19 ], Spain [ 20 ] and France [ 21 ] following 572, 307 and 1378 adults with T1DM, respectively, using the FreeStyle Libre system (Abbott Laboratories, Alameda, CA, USA), with data covering the periods before and during lockdown. In the first two studies, percent time in range (%TIR) 70–180 mg/dL (3.9–10 mmol/L), over this period increased, with associated improvements in glycaemic variability and estimated HbA1c (eA1c), and in the third study average glucose decreased.…”

Section: The Success Of Sensor-augmented Care and Telemonitoring In Diabetesmentioning

confidence: 99%

“…For example, indexes of social deprivation are associated with lower rates of treatment target achievement [ 57 ], and people with lower income levels have been shown to have lower engagement with eHealth [ 58 , 59 ]. More tellingly, socio-economic deprivation was found to be an independent predictor of a ≥ 5% decline in %TIR for people with diabetes during COVID-19-enforced social distancing, despite their use of CGM technology [ 19 ]. This is exacerbated by the variation in levels of internet access between different European regions.…”

Section: Ehealth Literacy In Diabetes Carementioning

confidence: 99%

The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond

et al. 2021

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Telemedicine in diabetes care has been evolving over several years, particularly since the advent of cloud-connected technologies for diabetes management, such as glucose monitoring devices, including continuous glucose monitoring (CGM) systems, that facilitate sharing of glucose data between people with diabetes and their healthcare professionals in near-real time. Extreme social distancing and shielding in place for vulnerable patients during the COVID-19 pandemic has created both the challenge and the opportunity to provide care at a distance on a large scale. Available evidence suggests that glucose control has in fact improved during this period for people with diabetes who are able to use CGM devices for remote glucose monitoring. The development of telemedicine as part of the standard of care in diabetes faces significant challenges in the European context, particularly in terms of providing consistent and effective care at a distance to large populations of patients while using robust systems that can be supported by large regional and national healthcare services. These challenges include a fragmented approach to healthcare technology assessment and reimbursement, lack of eHealth education and literacy, particularly amongst healthcare professionals, lack of data integration, as well as concerns about electronic health records, patient consent and privacy. Here we review the benefits of and challenges to wider application of telemedicine and telemonitoring in the post-pandemic future, with the aim to ensure that the value of these eHealth services is provided to patients, healthcare providers and health systems.

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“…In Scotland, a large socioeconomic gap has been reported for all-cause mortality [ 6 ], and with respect to all-cause mortality before age 50 [ 7 ] for the population with type 1 diabetes. Socioeconomic differences have also been identified regarding the management of type 1 diabetes, such as glucose control [ 8 , 9 ] and complications, including the prevalence of diabetic neuropathy [ 10 ] and diabetic retinopathy [ 11 ]. The Scottish Government’s most recent Diabetes Improvement Plan (2021–2026) stated that addressing the challenges associated with socioeconomic inequalities in access to care and health outcomes among the population with type 1 diabetes needs to be a priority [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018

et al. 2022

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Background We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes. Methods This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50. Results At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 − 22.8) for males and 25.1 years (95% CI: 24.4 − 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 − 19.9) vs. 26.3 years (95% CI: 24.5 − 28.1) among males, and 21.2 years (95% CI: 19.7 − 22.7) vs. 29.3 years (95% CI: 27.5 − 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 − 6.1) vs. 9.3 years (95% CI: 7.5 − 11.1) among males, and 5.3 years (95% CI: 3.7 − 6.9) vs. 10.3 years (95% CI: 8.3 − 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking. Conclusions In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications.

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Socioeconomic deprivation, technology use, C‐peptide, smoking and other predictors of glycaemic control in adults with type 1 diabetes

Cited by 18 publications

References 27 publications

The impact of socio‐economic deprivation on access to diabetes technology in adults with type 1 diabetes

The impact of socio‐economic deprivation on access to diabetes technology in adults with type 1 diabetes

The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond

Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013–2018

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