medwireNews: People from the lowest socioeconomic strata have a reduced likelihood of improving their glycemic control after attending a type 1 diabetes education course, shows UK research.
Callum Innes (Glasgow Royal Infirmary) and colleagues looked at the outcomes of 335 people with type 1 diabetes who completed the 5-day DAFNE diabetes education course at an average age of 45 years, having been diagnosed at an average age of 22 years.
Their glycated hemoglobin (HbA1c) level fell by an average of 2.5 mmol/mol (0.2%), from a baseline of 72 mmol/mol (8.7%), across four approximately annual measurements taken before and after DAFNE attendance.
However, 50% of people in the most deprived quintile had an increase in HbA1c of at least 2.5 mmol/mol (0.2%), despite completing the DAFNE course, compared with just 22% of those in the least deprived quintile, and the corresponding proportions with no change were 14% and 20%. Conversely, fewer people in the most versus least deprived quintiles achieved a decrease, at 36% and 59%, respectively.
This amounted to a 75% reduction in the risk for no change or an increase in HbA1c among people in the least versus the most deprived quintiles after accounting for confounders including baseline HbA1c.
Baseline glycemic control was the factor most strongly associated with achieving an HbA1c reduction, with this occurring in 64% of people with baseline HbA1c levels of 80–120 mmol//mol (9.5–13.1%), compared with 24% of those with levels of 40–60 mmol/mol (5.8–7.6%).
“While this may partly reflect regression to the mean, this finding supports existing DAFNE referral criteria based on high HbA1c levels,” write the researchers in Diabetic Medicine.
However, they stress that people in the lowest two quintiles of socioeconomic status did not, on average, achieve a reduction in HbA1c despite having higher baseline levels than the better off groups.
Innes and team suggest that educational attainment may contribute to this apparent reduced benefit of diabetes education in people of low socioeconomic status.
“DAFNE is an intensive five consecutive day course, covering a large volume of information and several potentially new concepts such as glycaemic indexes,” they say, adding that some elements of the course “rely heavily on numeracy skills.”
Noting also the course’s focus on avoiding hypoglycemia, they suggest that “those less confident in their numeracy skills may be more conservative in their estimates for insulin administration.”
The researchers suggest that their findings “raise questions regarding the delivery of DAFNE education itself and whether it is pitched at [a] level that is appropriately accessible.”
However, they stress that education alone is unlikely to remove deprivation-related variability in glycemic control, given issues such as barriers to achieving a healthy diet and exercise and the financial insecurity faced by people with low socioeconomic status.
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