Social inequalities and outcomes in type 2 diabetes in the German region of Augsburg. A cross-sectional survey

Abstract

Objectives: To assess the association of socioeconomic position with health (care) outcomes in type 2 diabetes with a particular focus on glycaemic control.

Methods: A cross-sectional survey in the region of Augsburg (Germany) on 373 men and women with type 2 diabetes, drawn from representative MONICA surveys and the myocardial infarct register. Analysis of association of socioeconomic position with HbAlc levels, cardiovascular risk factors and long-term macro- and microvascular diabetes complications using logistic regression models.

Results: Glycaemic control, measured by HbAlc levels, is strongly associated with indicators of socioeconomic position favouring the better off. Comparison of the lowest with the highest socioeconomic group showed an odds ratio of 2.49 (95% CI: 1.22-5.07) for the MI register subgroup and 1.80 (95% CI: 0.80-4.06) for the survey subgroup for failure to achieve the recommended HbAlc target. This association could not be accounted for by differences across social groups in age, sex, diabetes duration, obesity, or physical activity.

Conclusions: Social inequalities in glycaemic control do exist. This finding may indicate a level of diabetes care that is inappropriate to the need of socially disadvantaged groups.