Social Determinants of Health on Glycemic Control in Pediatric Type 1 Diabetes
Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: . The Journal of pediatrics
(Impact Factor: 3.79).
01/2013; 162(4). DOI: 10.1016/j.jpeds.2012.12.010
To evaluate the relationship between the social determinants of health (SDH) and glycemic control in a large pediatric type 1 diabetes (T1D) population.
Deprivation Indices (DI) were used to ascertain population-level measures of socioeconomic status, family structure, and ethnicity in patients with T1D followed at The Hospital for Sick Children August 2010-2011 (n = 854). DI quintile scores were determined for individual patients based on de-identified postal codes, and linked to mean patient A1Cs as a measure of glycemic control. We compared mean A1C between the most and least deprived DI quintiles. Associations were estimated controlling for age and sex, and repeated for insulin pump use.
The T1D population evaluated in this study was most concentrated in the least and most deprived quintiles of the Material DI. A1C levels were highest in patients with the greatest degree of deprivation (fifth vs first quintile) on the Material DI (9.2% vs 8.3%, P < .0001), Social DI (9.1% vs 8.3%, P < .0001), and Ethnic Concentration Index (8.9% vs 8.4%, P = .03). These relationships between measures of the SDH and A1C were not evident for patients on insulin pumps. On regression analysis, higher A1C was predicted by older age, female sex, not using pump therapy, and being in the most deprived quintile for Material and Social Deprivation, but not Ethnic Concentration.
Measures of the SDH comprising Material and Social Deprivation were significantly associated with suboptimal glycemic control in our pediatric T1D cohort. Use of insulin pump therapy also predicted A1C and may have a moderating effect on these relationships.
Available from: Stephen T Lawless
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To evaluate the association between the frequency of visits and glycated hemoglobin (GHb) measurements on glycemic control in youth with type 1 diabetes. Research Design and Methods: A retrospective longitudinal cohort study of 1449 youth (mean age 11.4 years, 50% female, 74% Caucasian, 24% with Medicaid) with type 1 diabetes followed at five pediatric endocrinology clinics from the years 2008 to 2011 was conducted. Utilizing hierarchical cluster analysis, three homogeneous groups of patients were generated: those with a relative increase in GHb (worsened, n = 237), no change in GHb (stable, n = 842), and decrease in GHb (improved, n = 370) over the study period. The number of visits and GHb obtained per year were compared between the three groups utilizing multinomial logistic regression analysis, using one visit or GHb per year as a reference and controlling for patient demographic and baseline characteristics. Results: Patients with quarterly visits were least likely to have worsened glycemic control (OR 0.33, p < 0 .05) and were most likely to have improved glycemic control (OR 3.48, p < 0.01). Patients with four GHb tests a year (OR 0.53, p < 0.05) were least likely to have worsened glycemic control. Conclusion: Quarterly visits and GHb testing are associated with glycemic control in youth with type 1 diabetes.
Diabetes care 09/2013; 37(2). DOI:10.2337/dc13-0980 · 8.42 Impact Factor
Available from: Anna Lindholm Olinder
09/2014; 31(7). DOI:10.1002/pdi.1883
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ABSTRACT: Comment expliquer les différences de pratiques de l’insulinothérapie par pompe externe, non seulement entre l’Europe et les États-Unis, et entre les pays européens, mais également d’un centre à l’autre et d’un médecin à l’autre ? Existe-t-il des barrières, chez les soignants et chez les patients, à l’utilisation d’une pompe à insuline ?
Médecine des Maladies Métaboliques 10/2014; 8(5). DOI:10.1016/S1957-2557(14)70867-3
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