Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
Hadoks (Elzha), The Hague, The Netherlands.
Int J Clin Pract. 2021 May;75(5):e13962. doi: 10.1111/ijcp.13962. Epub 2021 Jan 24.
Structured primary diabetes care within a collectively supported setting is associated with better monitoring of biomedical and lifestyle-related target indicators amongst people with type 2 diabetes and with better HbA1c levels. Whether socioeconomic status affects the delivery of care in terms of monitoring and its association with HbA1c levels within this approach, is unclear. This study aims to understand whether, within a structured care approach, (1) socioeconomic categories differ concerning diabetes monitoring as recommended; (2) socioeconomic status modifies the association between monitoring as recommended and HbA1c.
Observational real-life cohort study with primary care registry data from general practitioners within diverse socioeconomic areas, who are supported with the implementation of structured diabetes care. People with type 2 diabetes mellitus were offered quarterly diabetes consultations. "Monitoring as recommended" by professional guidelines implied minimally one annual registration of HbA1c, systolic blood pressure, LDL, BMI, smoking behaviour and physical activity. Regarding socioeconomic status, deprived, advantageous urban and advantageous suburban categories were compared to the intermediate category concerning (a) recommended monitoring; (b) association between recommended monitoring and HbA1c.
Aim 1 (n = 13 601 people): Compared to the intermediate socioeconomic category, no significant differences in odds of being monitored as recommended were found in the deprived (OR 0.45 (95% CI 0.19-1.08)), advantageous urban (OR 1.27 (95% CI 0.46-3.54)) and advantageous suburban (OR 2.32 (95% CI 0.88-6.08)) categories. Aim 2 (n = 11 164 people): People with recommended monitoring had significantly lower HbA1c levels than incompletely monitored people (-2.4 (95% CI -2.9; -1.8) mmol/mol). SES modified monitoring-related HbA1c differences, which were significantly higher in the deprived (-3.3 (95% CI -4.3; -2.4) mmol/mol) than the intermediate category (-1.3 (95% CI -2.2; -0.4) mmol/mol).
Within a structured diabetes care setting, socioeconomic status is not associated with recommended monitoring. Socioeconomic differences in the association between recommended monitoring and HbA1c levels advocate further exploration of practice and patient-related factors contributing to appropriate monitoring and for care adjustment to population needs.
在集体支持的环境下进行结构化的初级糖尿病护理与 2 型糖尿病患者的生物医学和生活方式相关目标指标监测改善以及糖化血红蛋白（HbA1c）水平降低有关。在这种方法下，社会经济地位是否会影响护理的提供，包括监测及其与 HbA1c 水平的关系，目前尚不清楚。本研究旨在了解在结构化护理方法下，（1）社会经济类别在推荐的糖尿病监测方面是否存在差异；（2）社会经济地位是否会改变推荐的监测与 HbA1c 之间的关联。
这是一项观察性真实世界队列研究，使用来自不同社会经济领域的基层医疗注册数据，这些数据来自于接受结构化糖尿病护理的基层医生。2 型糖尿病患者每季度接受一次糖尿病咨询。专业指南推荐的“监测”意味着每年至少有一次 HbA1c、收缩压、LDL、BMI、吸烟行为和身体活动的登记。关于社会经济地位，与中等类别相比，贫困、有利的城市和有利的郊区类别在（a）推荐的监测；（b）推荐监测与 HbA1c 之间的关联方面进行了比较。
目标 1（n=13601 人）：与中等社会经济类别相比，贫困（比值比 0.45（95%可信区间 0.19-1.08））、有利的城市（比值比 1.27（95%可信区间 0.46-3.54））和有利的郊区（比值比 2.32（95%可信区间 0.88-6.08））类别中推荐监测的可能性没有显著差异。目标 2（n=11164 人）：接受推荐监测的患者 HbA1c 水平明显低于监测不充分的患者（-2.4（95%可信区间-2.9；-1.8）mmol/mol）。社会经济地位改变了监测相关的 HbA1c 差异，与中等类别相比，贫困类别（-3.3（95%可信区间-4.3；-2.4）mmol/mol）的差异明显更高（-1.3（95%可信区间-2.2；-0.4）mmol/mol）。
在结构化的糖尿病护理环境中，社会经济地位与推荐的监测无关。在推荐监测与 HbA1c 水平之间的关联方面，社会经济差异表明，与中等类别相比，贫困类别中适当监测的实践和患者相关因素存在差异，需要进一步探索，以调整护理以满足人群需求。
