Article Text
Abstract
Objectives The aim of this research is to study education, income and immigration as risk factors for high hemoglobin A1c (HbA1c >70 mmol/mol (8.6%)) when diagnosed with type 2 diabetes (T2D) or latent autoimmune diabetes in the adult (LADA).
Research design and methods Patients were included from the All New Diabetics in Scania study (2008-2013). Level of education, disposable income and immigration year were retrieved from the longitudinal integrated database for labour market research (LISA) register compiled by Statistics Sweden. Logistic regression models were used to estimate ORs for HbA1c >70 mmol/mol (8.6%) at diagnosis.
Results A total of 3794 patients with incident T2D (n=3 525) or LADA (n=269) were included. Patients with T2D with a low (≤9 years) or medium (10-12 years) levels of education were more likely to have high HbA1c at diagnosis compared with patients with T2D with a high (>12 years) level of education (OR 1.34, 95% CI 1.08 to1.66, OR 1.26, 95% CI 1.03 to 1.54). Low-income patients with T2D (<60% of median) were more likely to have high HbA1c at diagnosis compared with high-income patients withT2D (>150% of median) (OR 1.35, 95% CI 1.02 to 1.79).
Conclusions Patients with lower levels of education or low income and are more likely to have HbA1c is >70 mmol/mol (8.6%) when diagnosed with T2D. An understanding of how socioeconomic position influences the clinical presentation at diagnosis may facilitate screening programs designed to target populations at risk for delayed diagnosis.
- Clinical Epidemiology
- HbA1c
- Type 2 Diabetes
- LADA (Latent Autoimmune Diabetes in Adults)
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Footnotes
Contributors MM wrote the manuscript. MM, JS, JH and RP contributed to the design of the study, conducted statistical analysis and participated in writing the manuscript. MD, LG, AR and PS collected and analyzed data. All authors read, revised it critically and approved the final version.
Competing interests None declared.
Patient consent This is a register study. All the registered participants have signed a consent form granted by the Central Ethical Review Board, Lund, Sweden. For this study all identifiable information is anonymized. It is not possible to link any clinical information to individuals.
Ethics approval Central Ethical Review Board, Lund, Sweden.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Additional unpublished data including country of origin, medication and genetic information are stored and handled by the ANDIS study. Information on how to access ANDIS data is available at