Knowledge about diabetes and participation in diabetes training courses: the need for improving health care for diabetes patients with low SES.

The association between socioeconomic status (SES) and health is well known, and many determinants of these health inequalities have been studied. Concerning the role of health care, the results are conflicting, though. The study adds to this discussion by focussing on health care differences for people with type 2 diabetes. The analyses are based on a study conducted in Southern Germany (WHO MONICA study, Augsburg myocardial infarction registry). The sample consists of 378 type 2 diabetic patients, divided into two clearly distinct groups: one group (n = 210) from a MI registry with clinically confirmed myocardial infarction (MI), the other (n = 168) from a population based survey, characterised by the absence of a previous MI. Ten topics are differentiated in the assessment of diabetes knowledge (diet, weight control, etc.). The analyses show that knowledge about diabetes increases with increasing educational level. Concerning "very well informed about diet", for example, the odds ratio for the high educational group is 3.45 (95 % CI: 1.34 - 8.86) as compared with the low educational group. This association is restricted to those diabetic persons with previous MI. For diet, the odds ratio for this subsample increases to 7.35 (p < 0.05). Similar results are seen for the other topics of diabetes knowledge. Also, diabetic persons with a low educational level participated in diabetes training courses least often, especially in the subsample with previous MI. Thus, taking the example of type 2 diabetes, the study adds to the evidence that the inverse care law is still present today in Germany.