Soliman Youstina, Everett Karl, Shulman Rayzel, Austin Peter C, Lipscombe Lorraine, Booth Gillian, Weisman Alanna
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
ICES, Toronto, Ontario, Canada.
Diabetes Obes Metab. 2025 Sep;27(9):4998-5007. doi: 10.1111/dom.16547. Epub 2025 Jun 24.
Social disadvantage is associated with worse diabetes outcomes among individuals with type 1 diabetes (T1D). Insulin pump therapy in the context of a publicly funded programme may mitigate the effects of social disadvantage on outcomes of diabetes. We investigated the effects of social disadvantage on health care use indicators and outcomes among pump users.
We conducted a population-based retrospective cohort study using administrative health data in Ontario, Canada. Adults with T1D who initiated pump therapy between 1 April 2012 and 30 March 2020 were included. Multivariable Poisson and linear regressions were used to evaluate associations between social disadvantage (defined by the material resources quintile of the Ontario marginalization index) and the following outcomes: health care use indicators (number of HbA1c tests and endocrinologist outpatient visits per year), and clinical outcomes (HbA1c and hospitalization/emergency department visits for hyperglycaemia and hypoglycaemia). All models were adjusted for age, sex, diabetes duration, baseline HbA1c, immigrant status, rural residence, diabetes physician specialty, clinic type and were estimated using generalized estimating equations (GEE) models to account for clustering by region.
Among 15 755 adults with T1D who initiated pump therapy, 14% were from the most socially disadvantaged quintile. There were no associations between social disadvantage and health care use indicators. Individuals with greater disadvantage had poorer diabetes outcomes, including 0.12% higher HbA1c (95% CI 0.06-0.17) and a higher rate for hospitalization/emergency department visits for hyperglycaemia [adjusted rate ratio (aRR) 2.07 (95% CI 1.64-2.62)] and hypoglycaemia [aRR 1.76 (95% CI 1.41-2.19)] comparing the most versus least socially disadvantaged quintiles.
Social disadvantage was associated with worse clinical outcomes but not health care use indicators among pump users with T1D in Ontario. Social disadvantage remains a risk factor for poorer clinical outcomes among pump users, but pump use may sustain greater engagement with the diabetes care team.
社会劣势与1型糖尿病（T1D）患者更差的糖尿病结局相关。在公共资助项目背景下的胰岛素泵治疗可能会减轻社会劣势对糖尿病结局的影响。我们调查了社会劣势对胰岛素泵使用者的医疗保健使用指标和结局的影响。
我们利用加拿大安大略省的行政卫生数据进行了一项基于人群的回顾性队列研究。纳入了2012年4月1日至2020年3月30日期间开始胰岛素泵治疗的成年T1D患者。使用多变量泊松回归和线性回归来评估社会劣势（由安大略边缘化指数的物质资源五分位数定义）与以下结局之间的关联：医疗保健使用指标（每年糖化血红蛋白[HbA1c]检测次数和内分泌科门诊就诊次数）以及临床结局（HbA1c以及因高血糖和低血糖导致的住院/急诊科就诊）。所有模型均根据年龄、性别、糖尿病病程、基线HbA1c水平、移民身份、农村居住情况、糖尿病医生专业、诊所类型进行了调整，并使用广义估计方程（GEE）模型进行估计，以考虑地区聚类情况。
在15755名开始胰岛素泵治疗的成年T1D患者中，14%来自社会劣势程度最高的五分位数。社会劣势与医疗保健使用指标之间无关联。劣势程度较高的个体糖尿病结局较差，与社会劣势程度最低的五分位数相比，HbA1c水平高0.12%（95%置信区间[CI] 0.06 - 0.17），因高血糖导致的住院/急诊科就诊率更高[调整率比（aRR）2.
07（95% CI 1.64 - 2.62）]，因低血糖导致的住院/急诊科就诊率更高[aRR 1.76（95% CI 1.41 - 2.19）]。
在安大略省使用胰岛素泵的T1D患者中，社会劣势与更差的临床结局相关，但与医疗保健使用指标无关。社会劣势仍然是胰岛素泵使用者临床结局较差的一个危险因素，但使用胰岛素泵可能会使患者与糖尿病护理团队保持更高的参与度。
