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Education, immigration and income as risk factors for hemoglobin A1c >70 mmol/mol when diagnosed with type 2 diabetes or latent autoimmune diabetes in adult: a population-based cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.ORCID iD: 0000-0002-4140-1981
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
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2017 (English)In: BMJ Open Diabetes Research and Care, Vol. 5, no 1Article in journal (Refereed) Published
Abstract [en]

Objectives The aim of this research is to study education, income and immigration as risk factors for high hemoglobin A1c (HbA1c &gt;70 mmol/mol (8.6%)) when diagnosed with type 2 diabetes (T2D) or latent autoimmune diabetes in the adult (LADA).Research design and methods Patients were included from the All New Diabetics in Scania study (2008-2013). Level of education, disposable income and immigration year were retrieved from the longitudinal integrated database for labour market research (LISA) register compiled by Statistics Sweden. Logistic regression models were used to estimate ORs for HbA1c &gt;70 mmol/mol (8.6%) at diagnosis.Results A total of 3794 patients with incident T2D (n=3 525) or LADA (n=269) were included. Patients with T2D with a low (<=9 years) or medium (10-12 years) levels of education were more likely to have high HbA1c at diagnosis compared with patients with T2D with a high (&gt;12 years) level of education (OR 1.34, 95% CI 1.08 to1.66, OR 1.26, 95% CI 1.03 to 1.54). Low-income patients with T2D (&lt;60% of median) were more likely to have high HbA1c at diagnosis compared with high-income patients withT2D (&gt;150% of median) (OR 1.35, 95% CI 1.02 to 1.79).Conclusions Patients with lower levels of education or low income and are more likely to have HbA1c is &gt;70 mmol/mol (8.6%) when diagnosed with T2D. An understanding of how socioeconomic position influences the clinical presentation at diagnosis may facilitate screening programs designed to target populations at risk for delayed diagnosis.

Place, publisher, year, edition, pages
BMJ Specialist Journals , 2017. Vol. 5, no 1
National Category
Public Health, Global Health, Social Medicine and Epidemiology Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:uu:diva-321637DOI: 10.1136/bmjdrc-2016-000346OAI: oai:DiVA.org:uu-321637DiVA: diva2:1096521
Available from: 2017-05-18 Created: 2017-05-18 Last updated: 2017-08-22
In thesis
1. Diabetes Mellitus at the Time for Diagnosis: Studies on Prognostic Factors
Open this publication in new window or tab >>Diabetes Mellitus at the Time for Diagnosis: Studies on Prognostic Factors
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim for this thesis was to identify prognostic factors for chronic diabetes complications that exist at the time of diabetes diagnosis.

Low level of education (<12 years) and low income (<60% of median) was found to increase the risk to have high (>70 mmol/mol) HbA1c at the time of diagnosis with 34 % and 35 %, respectively.

Prevalence of diabetic retinopathy (DR) was 12% in a cohort of patients newly diagnosed with diabetes. Diabetic macular edema was present in 11% of patients with type 2 diabetes (T2D) and 13% of those with Latent Autoimmune Diabetes in Adults (LADA). Low beta cell function and low level of education increased the risk for DR with 110% and 43%, respectively. For every unit of increase in body mass index, the risk for DR was reduced by 3%.

The cellular immunology of LADA patients was a mixture of that observed in both type 1 (T1D) and T2D patients. Compared to patients with T1D, LADA patients had more B-regulatory lymphocytes and antigen presenting cells capable of producing interleukine-35. This indicates a higher anti-inflammatory capacity in LADA patients compared to type T1D patients.

By imputing age, body mass index, HbA1c at diagnosis, beta cell function and insulin resistance in a cluster analysis, five distinct diabetes clusters were identified. The four clusters representing T2D patients differed in incidence of DR, nephropathy and non-alcoholic fatty liver disease. This was replicated with similar results in three geographically separate populations.

By studying socioeconomic background and factors present at the time of diagnosis we can better predict prognosis for chronic diabetes complications. These findings may facilitate better-targeted diabetes screening programs and more individually tailored treatment regimes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 87 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1361
Keyword
New-onset Diabetes Mellitus, socioeconomic position, epidemiology, diabetes complications, diabetic retinopathy, cellular immunology, diabetes classification, type 2 diabetes, latent autoimmune diabetes in adults (LADA), type 1 diabetes
National Category
Family Medicine
Research subject
Family Medicine; Endocrinology and Diabetology
Identifiers
urn:nbn:se:uu:diva-328382 (URN)978-91-513-0047-4 (ISBN)
Public defence
2017-10-13, Auditorium Minus, Gustavianum, Akademigatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Funder
EXODIAB - Excellence of Diabetes Research in Sweden, 2009-1039
Available from: 2017-09-21 Created: 2017-08-22 Last updated: 2017-10-17

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