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Cited by 28Diabetes Management and ResearchDiabetes Management and EducationHealth disparities and outcomes

Associations Between Socioeconomic Status and Patient Experience With Type 1 Diabetes Management and Complications: Cross-sectional Analysis of a Cohort From Québec, Canada

Talbo, Meryem Khadija, Katz, Alexandra, Dostie, Michel, Legault, Laurent, Brazeau, Anne-Sophie·2022·Canadian Journal of Diabetes
DOI 10.1016/j.jcjd.2022.02.008
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Abstract

Background Low socioeconomic status (SES) may add to the challenges of type 1 diabetes (T1D) management and be an independent risk factor for chronic and acute diabetes complications. Our aim in this study was to evaluate the association between SES and TID management and risk of complications in a universal health-care system using data from a registry of people living with T1D (PWT1D) in Québec, Canada (the BETTER registry).Methods This study was a cross-sectional analysis describing the association between SES factors (education, income, employment and insurance coverage) and T1D outcomes (glycated hemoglobin [A1C], acute and chronic complications and comorbidities), using chi-square tests and regression analyses (adjusted for diabetes duration, sex, ethnicity and diabetes technology use).Results In a sample of 1,333 PWT1D, lower education level was associated with cardiovascular disease (odds ratio [OR], 2.44; p=0.002), depression (OR, 1.56; p=0.020), nephropathy (OR, 2.10; p=0.001) and higher A1C (OR, 1.79; p<0.001). Low-income groups were more likely to report higher A1C (OR, 2.16; p=0.001), retinopathy (OR, 1.84; p=0.038), neuropathy (OR, 1.89; p=0.043), nephropathy (OR, 2.23; p=0.024), severe hypoglycemia (OR, 1.87; p=0.022) and depression (OR, 1.87; p=0.012). Unemployment was associated with retinopathy (OR, 2.37; p=0.009) and neuropathy (OR, 1.96; p=0.035). Diabetic ketoacidosis (OR, 2.81; p=0.001) and neuropathy (OR, 1.67; p=0.020) were more likely to be reported by participants with public insurance.Conclusions PWT1D from lower SES, particularly those with low income and low education, were more likely to report T1D-related complications and comorbidities. Further longitudinal investigations are needed to better understand the nature and directionality of these associations.

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  • The role of hybrid closed loop and advanced hybrid closed loop systems in managing glucocorticoid-induced glycaemic excursions remains under development and is constrained by issues of accessibility and affordability.

    “HCL and AHCL systems may help buffer variability; their role in this setting remains under development and is further constrained by issues of accessibility and affordability.”

    From A systematic review of glucocorticoid use in type 1 diabetes: Glycaemic effects and clinical management strategies (2026) · cites this paper as [70]

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Authors
Talbo, M. K., Katz, A., Dostie, M., Legault, L., & Brazeau, A.-S.
Affiliations
  • McGill University (CA)
  • Montreal Clinical Research Institute (CA)
Corresponding author
Brazeau, Anne-Sophie
ORCID
Venue
Canadian Journal of Diabetes
Publisher
Elsevier BV
Published
2022-08
Volume
46
Issue
6
Pages
569-577
ISSN
1499-2671 (ISSN-L)
DOI
10.1016/j.jcjd.2022.02.008
OpenAlex
W4214932501
Cited by
28
References
32
Citations by year
2026: 3 · 2025: 9 · 2024: 12 · 2023: 4
FWCI
4.65
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Canadian Journal of Diabetes (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Canadian Institutes of Health Research (JT1-157204)
  • Fonds de Recherche du Québec - Santé
  • Sanofi
  • Novo Nordisk
  • Juvenile Diabetes Research Foundation Canada (4-SRA-2018-651-Q-R)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Health › Health disparities and outcomes
Keywords
type 1 diabetes, socioeconomic status, diabetes complications, HbA1c, diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, severe hypoglycemia, diabetic ketoacidosis, depression, cardiovascular disease, income, unemployment, insurance coverage, health disparities, Quebec, universal health care, diabetes management, comorbidities, diabetes duration
MeSH terms
Cross-Sectional Studies, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Quebec, Retinal Diseases, Social Class, Diabetes Complications, Patient Outcome Assessment

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