Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands.
Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands.
Diabetes Metab Res Rev. 2018 Sep;34(6):e3008. doi: 10.1002/dmrr.3008. Epub 2018 May 22.
Up until now, differences in HbA levels by socio-economic status (SES) have been identified, but not yet quantified in people with type 2 diabetes. The aim of this study was therefore to assess the difference in HbA levels between people with type 2 diabetes of different SES in a systematic review and meta-analysis. A systematic literature search was conducted in MEDLINE, Embase, Ebsco, and the Cochrane Library until January 14, 2018. Included studies described adults with type 2 diabetes in whom the association between SES and HbA levels was studied. Studies were rated for methodological quality and data were synthesized quantitatively (meta-analysis) and qualitatively (levels of evidence), stratified for type of SES variable, i.e., education, income, deprivation, and employment. Fifty-one studies were included: 15 high, 27 moderate, and 9 of low methodological quality. Strong evidence was provided that people of low SES have higher HbA levels than people of high SES, for deprivation, education, and employment status. The pooled mean difference in HbA levels between people of low and high SES was 0.26% (95% CI, 0.09-0.43) or 3.12 mmol/mol (95% CI, 1.21-5.04) for education and 0.20% (95% CI, -0.05 to 0.46) or 2.36 mmol/mol (95%CI, -0.61 to 5.33) for income. In conclusion, our systematic review and meta-analysis showed that there was an inverse association between SES and HbA levels in people with type 2 diabetes. Future research should focus on finding SES-sensitive strategies to reduce HbA levels in people with type 2 diabetes.
到目前为止，已经确定了社会经济地位（SES）对 HbA 水平的差异，但尚未在 2 型糖尿病患者中进行量化。因此，本研究旨在通过系统评价和荟萃分析评估不同 SES 的 2 型糖尿病患者之间的 HbA 水平差异。在 MEDLINE、Embase、Ebsco 和 Cochrane 图书馆中进行了系统的文献检索，检索时间截至 2018 年 1 月 14 日。纳入的研究描述了患有 2 型糖尿病的成年人，研究了 SES 与 HbA 水平之间的关系。对研究进行了方法学质量评估，并对数据进行了定量（荟萃分析）和定性（证据水平）综合分析，按 SES 变量的类型分层，即教育、收入、贫困和就业。共纳入 51 项研究：15 项为高质量，27 项为中质量，9 项为低质量。有强有力的证据表明，与 SES 较高的人群相比，SES 较低的人群 HbA 水平较高，这与贫困、教育和就业状况有关。SES 较低和较高的人群之间 HbA 水平的平均差异为 0.26%（95%CI，0.09-0.43）或 3.12mmol/mol（95%CI，1.21-5.04），这是由于教育水平不同；收入为 0.20%（95%CI，-0.05 至 0.46）或 2.36mmol/mol（95%CI，-0.61 至 5.33），这是由于收入水平不同。总之，本系统评价和荟萃分析表明，2 型糖尿病患者的 SES 与 HbA 水平呈负相关。未来的研究应集中于寻找敏感 SES 的策略，以降低 2 型糖尿病患者的 HbA 水平。
