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Socioeconomic deprivation, technology use, C‐peptide, smoking and other predictors of glycaemic control in adults with type 1 diabetes
Author(s) -
Dover Anna R.,
Strachan Mark W. J.,
McKnight John A.,
Stimson Roland H.,
Mackenzie Scott D.,
Lyall Marcus J.,
Wright Rohana J.,
Forbes Shareen,
Gibb Fraser W.
Publication year - 2021
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14445
Subject(s) - medicine , diabetes mellitus , type 1 diabetes , socioeconomic status , type 2 diabetes , multivariate analysis , insulin , c peptide , endocrinology , environmental health , population
Aims Intensive glycaemic control is associated with substantial health benefits in people with type 1 diabetes. We sought to examine clinical and demographic factors associated with meeting glycaemic targets in type 1 diabetes. Methods We conducted a cross‐sectional analysis of 4594 individuals with type 1 diabetes. The primary outcome of the study was assessing factors associated with meeting HbA 1c targets. Secondary endpoints included factors associated with continuous subcutaneous insulin infusion (CSII) use and persistent C‐peptide secretion. Results Socioeconomic deprivation was strongly associated with a lower likelihood of achieving an HbA 1c <58 mmol/mol (7.5%) (20% in the most deprived quintile vs. 40% in the least deprived, p < 0.001). In multivariate analysis, absence of smoking history (OR 3.06, p < 0.001), flash monitoring (OR 1.49, p < 0.001), CSII (1.43, p = 0.022) and longer diabetes duration (OR 1.02 per year, p = 0.004) were independently associated with achieving HbA 1c <58 mmol/mol (7.5%), whereas increasing age (OR 0.99 per year, p = 0.004) and C‐peptide <50 pM (OR 0.58, p < 0.001) were associated with a lower likelihood of meeting this target. Low C‐peptide (<50 pM) was less likely in men (OR 0.55, p < 0.001) and never smokers (0.44, p < 0.001) in multivariate analysis. Conclusions Lower levels of deprivation, non‐smoking, higher C‐peptide, technology use, lower BMI and male gender were all associated with a higher likelihood of meeting HbA 1c targets. Access to proven diabetes treatments is lower in the most deprived individuals. Urgent efforts are required to provide treatments which are effective across the socioeconomic gradient.