title: Deprivation impedes success of insulin intensification in children and adolescents with Type 1 diabetes; longitudinal linear mixed modelling of a retrospective observational cohort.
abstract: OBJECTIVE
  To examine the relationship between social deprivation, intensification of insulin therapy (≥ three injections per day) and diabetes control in children and adolescents.
  
  
  METHODS
  We performed a longitudinal observational study of 283 children and adolescents with Type 1 diabetes from three UK paediatric centres from 2005 to 2007. We used linear mixed modelling to identify the contribution of the Index of Multiple Deprivation 2004, insulin regimen and demographic factors in explaining longitudinal differences in HbA(1c) levels.
  
  
  RESULTS
  Overall mean HbA(1c) levels were 8.9% [sd 1.4, 74 mmol/mol (8 mmol/mol)]. Prescribing of intensive therapy increased from 49.2 to 70.1% (χ(2) = 32.9, P < 0.001), but there was no corresponding improvement in HbA(1c) levels. Those from more educationally deprived backgrounds were less likely to be started on intensive therapy (P = 0.04). In linear mixed modelling, factors independently associated with poor metabolic control were greater social deprivation (P = 0.01), particularly lower educational levels (P = 0.006), and non-White ethnicity (P = 0.04). Nested terms analysis showed that increased deprivation interacted with non-White ethnicity (P = 0.009) and with intensive insulin therapy (P = 0.03) to result in poorer metabolic control. In a subgroup intensified from conventional regimens during follow-up (n = 75), greater social deprivation was associated with least success of intensive therapy (P = 0.02).
  
  
  CONCLUSIONS
  Social deprivation was associated with low uptake and poor success of insulin intensification and this appeared to be largely mediated via lower educational levels.
authors.affiliation: Royal Sussex County Hospital, Brighton, UK.
authors.forename: P
authors.initials: P
authors.lastname: Hine
authors.forename: S
authors.initials: S
authors.lastname: Senniappan
authors.forename: V
authors.initials: V
authors.lastname: Sankar
authors.forename: R
authors.initials: R
authors.lastname: Amin
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin; D008297:Male; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin