title: Screening for deprivation using the EPICES score: a tool for detecting patients at high risk of diabetic complications and poor quality of life.
abstract: OBJECTIVE
  Deprivation has been linked to more complicated and uncontrolled diabetes. The validated Évaluation de la précarité et des inégalités de santé dans les centres d'examens de santé (EPICES; Evaluation of the Deprivation and Inequalities of Health in Healthcare Centres) score could help to identify such deprived patients. The present study evaluated the relationships between deprivation and prevalence of complications, uncontrolled diabetes and quality of life.
  
  
  METHODS
  This prospective study was conducted in the diabetology department of a tertiary university hospital from November 2006 to July 2007. Patients with diabetes were divided into two groups, according to their deprivation status [non-deprived: EPICES score<30.17; deprived: EPICES score≥30.17 (56.5%)]. Diabetes control, complications and quality of life [Short Form Health Survey (SF-36)] were compared in the two groups.
  
  
  RESULTS
  Of a total of 102 patients, 97 completed all of the questionnaires: 18 had type 1 diabetes and 79 had type 2 diabetes, in a geographical area moderately affected by deprivation. No statistical relationship could be demonstrated between deprivation and HbA(1c). Deprived patients with diabetes presented with higher levels of fasting blood glucose, lower levels of LDL cholesterol and a significantly higher risk of obesity (P=0.0020). As for complications, microalbuminuria was linked to deprivation (P=0.03), but no associations with other complications were found. Quality of life was poorer for all physical, mental and social dimensions in deprived patients.
  
  
  CONCLUSIONS
  In this diabetic population, deprivation and glycaemic control were not associated. However, more deprived subjects with diabetes were at higher risk of renal disease. A deprived state was related to an altered quality of life as assessed by the SF-36 score.
authors.affiliation: Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, Hôpital Avicenne, AP-HP, Paris XIII University, 125, route de Stalingrad, 93009 Bobigny cedex, France. helene.bihan@avc.aphp.fr
authors.forename: H
authors.initials: H
authors.lastname: Bihan
authors.forename: M
authors.initials: M
authors.lastname: Ramentol
authors.forename: M
authors.initials: M
authors.lastname: Fysekidis
authors.forename: C
authors.initials: C
authors.lastname: Auclair
authors.forename: L
authors.initials: L
authors.lastname: Gerbaud
authors.forename: F
authors.initials: F
authors.lastname: Desbiez
authors.forename: F
authors.initials: F
authors.lastname: Peyrol
authors.forename: P
authors.initials: P
authors.lastname: Thieblot
authors.forename: R
authors.initials: R
authors.lastname: Cohen
authors.forename: I
authors.initials: I
authors.lastname: Tauveron
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D048909:Diabetes Complications / Q000097:blood / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology*; D003928:Diabetic Nephropathies / Q000453:epidemiology; D003929:Diabetic Neuropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011203:Poverty; D015995:Prevalence; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids; C517652:hemoglobin A1c protein, human