title: Differences in the quality of diabetes care caused by social inequalities disappear after treatment and education in a tertiary care centre.
abstract: OBJECTIVE
  To assess the relationship between social status and quality of diabetes care in a tertiary care centre in Germany.
  
  
  METHODS
  Social status was assessed in 940 consecutive patients in a university outpatient department by a questionnaire. The assessment comprised three components: education, highest professional position and household net income (total score 3-21). Quality of diabetes care was measured by HbA(1c) , blood pressure and BMI. The influence of social status on quality measures was analysed at entry and last visit by fitting linear mixed models.
  
  
  RESULTS
  At the entry visit, patients with lower social status had a higher HbA(1c) compared with patients with higher status (0.06% per each point of social score difference). After a mean follow- up of 6.0 years (Type 2 diabetes) and 9.4 years (Type 1 diabetes) no significant differences in HbA(1c) could be found. However, difference in BMI (-0.41 kg/m² per each point of social score) persisted at last observation. Blood pressure was only negligibly affected by the care programme.
  
  
  CONCLUSIONS
  Low social status is associated with worse quality of diabetes care at entry in a tertiary care centre. The differences in HbA(1c) disappeared after treatment and structured education, whereas the difference in BMI persisted. There was no significant influence of social status or treatment on blood pressure.
authors.affiliation: Department of Medicine III, University Hospital, Information Sciences and Documentation, University Hospital Jena, Jena, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Bäz
authors.forename: N
authors.initials: N
authors.lastname: Müller
authors.forename: E
authors.initials: E
authors.lastname: Beluchin
authors.forename: C
authors.initials: C
authors.lastname: Kloos
authors.forename: T
authors.initials: T
authors.lastname: Lehmann
authors.forename: G
authors.initials: G
authors.lastname: Wolf
authors.forename: U A
authors.initials: UA
authors.lastname: Müller
mesh_terms: D000328:Adult; D001794:Blood Pressure; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards*; D012923:Social Class; D011795:Surveys and Questionnaires
chemical_list: D006442:Glycated Hemoglobin