Kirsten Mönkemöller1, Esther Müller-Godeffroy2, Eggert Lilienthal3, Bettina Heidtmann4, Marianne Becker5, Lutz Feldhahn6, Markus Freff7, Dörte Hilgard8, Beate Krone9, Matthias Papsch10, Andrea Schumacher11, Karl O Schwab12, Heidemarie Schweiger13, Johannes Wolf14, Esther Bollow15,16, Reinhard W Holl15,16. 1. Department of Pediatrics, Kinderkrankenhaus Amsterdamer Straße, Cologne, Germany. 2. Department of Pediatrics, Universitäts Kampus Schleswig Holstein, Lübeck, Germany. 3. Department of Pediatrics, University Hospital St. Josef Bochum, Bochum, Germany. 4. Department of Pediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany. 5. Department of Pediatrics, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany. 6. Department of Pediatrics, Klinik für Kinder- und Jugendmedizin Böblingen, Böblingen, Germany. 7. Department of Pediatrics, Kinderkliniken Prinzessin Margaret, Darmstadt, Germany. 8. Department of Pediatrics, Pediatric Practice, Witten, Germany. 9. Department of Pediatrics, Klinikum Bremen-Nord, Bremen, Germany. 10. Department of Pediatrics, Marienhospital, Gelsenkirchen, Germany. 11. Department of Pediatric Endocrinology, Medical Center, Endokrinologikum, Ulm, Germany. 12. Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany. 13. Department of Pediatrics, Klinikum Fürth, Fürth, Germany. 14. Department of Pediatrics, St. Vincenz-Krankenhaus, Paderborn, Germany. 15. Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany. 16. German Center for Diabetes Research (DZD), Neuherberg, Germany.
Abstract
OBJECTIVE: To evaluate the association between socioeconomic status (SES) and diabetes outcomes in German children and adolescents. METHODS: A total of 1829 subjects <18 years old with type 1 diabetes mellitus from 13 German diabetes centers were included from June 2013 until June 2014. Data were collected within the multicenter DPV (Diabetes Prospective Follow-up) registry. SES was measured with a composite index. Multivariable regression models were applied to analyze the association of SES and outcomes adjusted for age, sex, diabetes duration, and migration status. RESULTS: Low SES was significantly associated with worse diabetes outcomes: higher hemoglobin A1C (HbA1c) (64.3 mmol/mol), lower proportion of insulin pump therapy (43.6%), fewer daily self-monitored blood glucose (SMBG) measurements (5.7), more inpatient days per patient-year (5.8) compared to patients with medium/high SES (HbA1c: 61.3 mmol/mol, P < 0.001/59.8 mmol/mol, P < 0.0001; proportion of pump therapy: 54.5%, P < 0.01/ 54.9%, P < 0.01; SMBG: 6.0, P < 0.01/ 6.1, P < 0.01; inpatient days: 4.5, P < 0.0001/3.4, P < 0.0001). The inclusion of migration status in the models resulted in only minor changes in the outcomes. CONCLUSION: Despite free health care, low SES is associated with unfavorable diabetes outcomes in Germany. The poorer diabetes outcomes of children with diabetes have been attributed to their migration status and may be partly explained by low SES. Both factors must become part of targeted diabetes care in children and adolescents with type 1 diabetes.
OBJECTIVE: To evaluate the association between socioeconomic status (SES) and diabetes outcomes in German children and adolescents. METHODS: A total of 1829 subjects <18 years old with type 1 diabetes mellitus from 13 German diabetes centers were included from June 2013 until June 2014. Data were collected within the multicenter DPV (Diabetes Prospective Follow-up) registry. SES was measured with a composite index. Multivariable regression models were applied to analyze the association of SES and outcomes adjusted for age, sex, diabetes duration, and migration status. RESULTS: Low SES was significantly associated with worse diabetes outcomes: higher hemoglobin A1C (HbA1c) (64.3 mmol/mol), lower proportion of insulin pump therapy (43.6%), fewer daily self-monitored blood glucose (SMBG) measurements (5.7), more inpatient days per patient-year (5.8) compared to patients with medium/high SES (HbA1c: 61.3 mmol/mol, P < 0.001/59.8 mmol/mol, P < 0.0001; proportion of pump therapy: 54.5%, P < 0.01/ 54.9%, P < 0.01; SMBG: 6.0, P < 0.01/ 6.1, P < 0.01; inpatient days: 4.5, P < 0.0001/3.4, P < 0.0001). The inclusion of migration status in the models resulted in only minor changes in the outcomes. CONCLUSION: Despite free health care, low SES is associated with unfavorable diabetes outcomes in Germany. The poorer diabetes outcomes of children with diabetes have been attributed to their migration status and may be partly explained by low SES. Both factors must become part of targeted diabetes care in children and adolescents with type 1 diabetes.
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