title: The association between socio-demographic marginalization and plasma glucose levels at diagnosis of gestational diabetes.
abstract: OBJECTIVE
  We examined the association between socio-demographic marginalization and plasma glucose levels at diagnosis of gestational diabetes in a multi-ethnic and socio-economically diverse patient group.
  
  
  METHODS
  Medical charts at a Toronto gestational diabetes clinic were reviewed for women with a recorded pregnancy between 1 March 2006 and 26 April 2011. One-hour 50-g glucose challenge test values and postal code data were abstracted. Postal codes were merged with 2006 Canadian census data to compute neighbourhood-level ethnic concentration (% recent immigrants, % visible minorities) and material deprivation (% low education, % low income, single-parent households). We compared women in the highest neighbourhood quintiles for both ethnic concentration and material deprivation with all other women to explore an association between marginalization and diagnostic glucose levels. Multivariate regression models of glucose challenge test values and insulin prescription were adjusted for age, prior gestational diabetes, parity and diabetes family history.
  
  
  RESULTS
  Among 531 patients with complete glucose challenge test data (mean 11.94 mmol/l, sd 1.83), those in the most marginalized neighbourhoods had 0.43 mmol/l higher glucose challenge test values (95% CI 0.08-0.78) compared with the rest of the study population. Other factors associated with higher glucose challenge test values were prior gestational diabetes (0.59 mmol/l increment, 95% CI 0.19-0.99) and diabetes family history (0.32 mmol/l increment, 95% CI -0.01 to 0.66). Each additional 1 mmol/l glucose challenge test result was associated with an increased likelihood of being prescribed insulin (odds ratio 1.33, 95% CI 1.17-1.51).
  
  
  CONCLUSIONS
  Women living in the most materially deprived and ethnically concentrated neighbourhoods have higher glucose levels at diagnosis of gestational diabetes. They may need close monitoring for timely initiation of insulin.
authors: Department of Geography, McGill University, Montreal, QC, Canada.
authors: L
authors: L
authors: Sampson
authors: K
authors: K
authors: Dasgupta
authors: N A
authors: NA
authors: Ross
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000188:drug therapy / Q000378:metabolism; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007182:Income / Q000706:statistics & numerical data; D007328:Insulin / Q000627:therapeutic use; D008913:Minority Groups / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D011247:Pregnancy; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012923:Social Class; D062487:Social Marginalization; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin