title: [Diabetes and social deprivation].
abstract: Diabetes prevalence is frequently associated with low socioeconomic status (SES), but little is known about the relationship between SES and diabetes control, follow-up and quality of life. We evaluated SES by using the EPICES score, an individual index of deprivation (Evaluation de la Précarité et des Inégalités de Santé dans les Centres d'Examen de Santé; Evaluation of Precariousness and Inequalities in Health Examination Centers). A total of 1686 subjects aged from 25 to 85 years were selected at random in Montpellier and 154 in Narbonne, of whom 126 were managed by a care network including diabetologists, general practitioners and nurses. Capillary glycemia, the body mass index (BMI), waist circumference (WC), and blood pressure were measured in all the subjects. HbA1c was measured in subjects with above-normal glycemia. Five hundred sixty-four subjects from the study population (190 diabetic patients, 292 subjects with non diabetic hyperglycemia, and 86 euglycemic subjects) were clinically evaluated and asked to complete a questionnaire covering socioeconomic status and diet. The data were then compared between deprived and non deprived subjects. One hundred sixty-one diabetic patients had a clinical examination and completed a detailed questionnaire including their history, therapy, control and follow-up of diabetes, perception of diabetes, quality of life, socioeconomic status and diet. The data were then compared between deprived and non deprived patients. One hundred twenty-six diabetic subjects managed by the AUDIAB care network were compared with 163 diabetics recruited in Montpellier, based on the same investigations and the same questionnaires. The data were compared between the overall patients and between deprived and non deprived patients. In the overall population, deprived subjects were younger and more frequently smokers, and had higher BMI than non deprived subjects. The overall prevalence of type 2 diabetes was 8.1%. Among patients younger than 65 years, deprived subjects had a higher prevalence of diabetes and non diabetic hyperglycemia than non deprived subjects (6.9% vs 4.4% and 22.8% vs 19.5%). More are unmarried males and 33% present with a significant level of education (secondary or university). Deprivation was associated with transport difficulties, vehicle acquisition, living in a private house, employment. More have few income to buy food and a large number use economic stores. They eat few proteins, fresh vegetables, fruits, dairy products and more often rice, pasta, tea, coffee and soft drinks. Most have their meals outside in economic restaurants. Dental problems are very common. 161 diabetic patients were evaluated Deprived diabetics were younger, more frequently males, more smokers with an increased BMI and WC. Among deprived diabetic patients, diabetes was diagnosed later on and less often by a systematic inquiry than in the non deprived group. Deprived patients presented with a poorer glycaemic control, more hypoglycaemic and ketosis events than non deprived subjects. They present with more difficulties to accept dietary and antidiabetic drugs. Insulin was less frequently used. Quality of life was impaired with an increased prevalence of anxiety and depression. Diabetic patients treated in the "Réseau de soins AUDIAB" presented with a better control of their disease and a better quality of life than patients treated out of the "Réseau". These data were confirmed whatever the level of deprivation.
authors.affiliation: Académie nationale de médecine. c.jaffiol@wanadoo.fr
authors.forename: Claude
authors.initials: C
authors.lastname: Jaffiol
authors.forename: Annick
authors.initials: A
authors.lastname: Fontbonne
authors.forename: Denyse
authors.initials: D
authors.lastname: Vannereau
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Olive
authors.forename: Serge
authors.initials: S
authors.lastname: Passeron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D005247:Feeding Behavior / Q000502:physiology; D005260:Female; D005602:France / Q000453:epidemiology; D005843:Geography; D006801:Humans; D008297:Male; D008875:Middle Aged; D011610:Psychosocial Deprivation; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires