The relationship between socioeconomic status and diabetes control and complications in the EURODIAB IDDM Complications Study.
OBJECTIVE
To determine whether there are socioeconomic differences in diabetes control and complications in people with IDDM.


METHODS
We conducted a prevalence survey of 1,217 men and 1,170 women with IDDM age 25-60 years from European clinics. Age at completion of education defined socioeconomic status: < or = 14 years defined those with primary education; 15-18 years, as secondary education; and > 19 years, as college education. Glycemic control, lipids, diet, retinopathy, neuropathy, and heart disease were assessed centrally.


RESULTS
People with a primary education were older and had diabetes for longer than those with a college education. The mean percentage of HbA1c was worst in the primary-educated men (6.6 vs. 6.1%, P = 0.0007 for trend) and women (6.5 vs. 6.0%, P = 0.0007). Total cholesterol level was higher in primary-educated than in college-educated men (5.6 vs 5.3 mmol/l, P = 0.002), as was triglyceride level (1.23 vs. 1.02 mmol/l, P = 0.0001). College-educated people were the least likely to be current smokers (P < 0.0001), and were most likely to partake in vigorous exercise (P < 0.001). Surprisingly, There was little difference in the prevalence of heart disease by educational status in men, while it was highest in the least educated women, but proliferative retinopathy was more common in primary- than in college-educated men (16 vs 10%, P = 0.04) as was macroalbuminuria (15 vs 9%, P = 0.03). Glycemic control could not fully account for these differences.


CONCLUSIONS
Healthy lifestyles are more prevalent in better educated men and women with IDDM, but these are not reflected in heart disease prevalence in men. The lower prevalence of severe microvascular complications in better educated men, unaccounted for by better glycemic control, requires further investigation.
Chaturvedi
N
N
Department of Epidemiology and Public Health, University College, London Medical School, U.K.
Stephenson
J M
JM
Fuller
J H
JH
D000328:Adult; D000419:Albuminuria / Q000453:epidemiology; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000503:physiopathology / Q000523:psychology*; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D003930:Diabetic Retinopathy / Q000453:epidemiology; D003927:Diet, Diabetic; D004493:Education; D005060:Europe; D015444:Exercise; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D012907:Smoking; D012959:Socioeconomic Factors; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D008076:Cholesterol, HDL; D008055:Lipids; D014280:Triglycerides; D002784:Cholesterol