Relationship between Glycemic control and socioeconomic status in secondary diabetes care setting

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 807-838-Diabetes - Diagnosis, Complications & Outcomes
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-833
MinSen Yew1, HweeChen Quek1, Hong Tar Khor*2 and Shaikh Abdul Shakoor3
1Tan Tock Seng Hospital, singapore, Singapore, 2Tan Tock Seng Hospital, Singapore, Singapore, 3Tantock Seng Hospital, Singapore, Singapore
Relationship between Glycemic control and socioeconomic status in secondary diabetes care setting

Background:
There is some evidence that lower socioeconomic status is associated with poor DM related health care, glycemic control, DM related complications and also mortality. HbA1C was inversely associated only with income level in one epidemiologic study from Pittsburgh (Secrest et al, 2011). The same study also reported higher incidence of autonomic neuropathy in low-income participants and higher incidence of end-stage renal disease and coronary artery disease. Diabetes care programme endowment charity fund is available in our endocrine clinic at TTSH to help the needy patients for using diabetes care consumables such as glucose test strips. The objectives were to explore disparities in diabetes care and control among diabetic patients, particularly evaluating the usefulness of our endowment programme in those patients with lower socioeconomic background.

Methods and Patients:

We undertook a retrospective, systemic review of patient’s records who had been followed-up in our Endocrine clinic (Clinic B2B) from January 2010 to December 2011. Patients with poor glycemic control (Hb A1C >8.5%) were selected, and their financial status was reviewed. The selected patients were classified accordingly into: 1) Endowment programme group (EG) of lower socioeconomic background with financial support, and 2) Standard care group (SG) without financial assistance.

Result:

Sixty-five out of 130 SG patients were female with mean age of 57.7 (standard deviation [SD], 12.5). Thirty-nine female patients were included in the EG with mean age of 56.49 (SD, 11.3) (P=0.24). The mean baseline HbA1c in the SG and EG reads 10.6%±1.1 and 10.8%±1.6 (P=0.11) respectively. Significant improvement over the glycemic control was reported for both groups during the subsequent follow-up. A significantly lower HbA1c was achieved in the EG with mean of 8.8% compared to 9.9% from the SG (P<0.05). The glycemic index plateaus after 1 year of follow-up (9.9% and 8.8% for SG and EG respectively). Seventeen percent (n=13) and 28% (n=20) of the patients in the EG achieved idea HbA1c of less than 7.5% at the 6-month follow-up and the end of study respectively. While, only 6% (n=8) and 12% (n=16) of patient in the SG achieved ideal A1c level at the 6-month follow-up and the end of study respectively.

Discussion:

Patient self-monitoring of blood glucose (SMBG) is currently considered as part of the multifactorial diabetic management recommended by American Diabetic Association, and more frequent SMBG is associated with clinically better glycemic control. However, SMBG is costly. This could be the major hinderer in optimal glycemic control, especially in lower socioeconomic group. From this study, we observed that by financing glucose strips to this group would significantly improve their glycemic outcome.

1. Secrest AM, Costacou T, Gutelius B, Miller RG, Songer TJ, Orchard TJ; Associations Between Socioeconomic Status and Major Complications in Type 1 Diabetes: The Pittsburgh Epidemiology of Diabetes Complication (EDC) Study. Ann Epidemiol. 2011 May;21(5):374-81.2. Sabanayagam C, Shankar A, Saw SM, Tai ES, Lim SC, Lee JJ, Wong TY; Prevalence of diabetes mellitus, glycemic control, and associated factors in a Malay population in Singapore. Asia Pac J Public Health. 2009 Oct;21(4):385-98. Epub 2009 Aug 5.3. Kater AJ et al. Self-monitoring of Blood Glucose Levels and Glycemic Control: the Northern California Kaiser Permanente Diabetes Registry. Am J Med. 2001;111:1–9

Nothing to Disclose: MY, HQ, HTK, SA

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm