Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study
Abstract Background Optimal glycaemia, reflected by glycated haemoglobin (HbA1c) levels, is key in reducing type 2 diabetes (T2D) complications. However, most people with T2D have suboptimal recall and understanding of HbA1c. Continuous glucose monitoring (CGM) measures glucose levels every 5 to 15-...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-07-01
|
| Series: | BMC Endocrine Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12902-018-0279-6 |
| _version_ | 1818273696334217216 |
|---|---|
| author | Mei Lyn Tan Jo-Anne Manski-Nankervis Sharmala Thuraisingam Alicia Jenkins David O’Neal John Furler |
| author_facet | Mei Lyn Tan Jo-Anne Manski-Nankervis Sharmala Thuraisingam Alicia Jenkins David O’Neal John Furler |
| author_sort | Mei Lyn Tan |
| collection | DOAJ |
| description | Abstract Background Optimal glycaemia, reflected by glycated haemoglobin (HbA1c) levels, is key in reducing type 2 diabetes (T2D) complications. However, most people with T2D have suboptimal recall and understanding of HbA1c. Continuous glucose monitoring (CGM) measures glucose levels every 5 to 15-min over days and may be more readily understood. Given that T2D is more common in lower socioeconomic settings, we aim to study relationships between socioeconomic status (SES) and percentage time in glucose target range (TIR) which is a key metric calculated from CGM. Methods Analysis of baseline data from the General Practice Optimising Structured MOnitoring To Improve Clinical outcomes (GP-OSMOTIC) randomised controlled trial (October 2016 – November 2017) of 300 people with T2D from 25 Victorian General Practices. FreeStyle Libre Pro® sensor patch was used for this study. SES was defined by the Index of Relative Socio-economic Disadvantage (IRSD) and educational attainment. Univariable and multivariable mixed-effects linear regression analyses controlling for age, BMI, diet, exercise and study arm were performed. Results One hundred and sixty-seven (60.1%) participants were male, the mean (SD) participant age was 61.0 (9.7) years, and the mean (SD) duration of CGM use was 12.3 (2.5) days. The 10th IRSD decile (least disadvantaged) was associated with a 15% higher TIR vs. the 1st decile (most disadvantaged) (95% CI 5, 25; p = 0.003) and a 0.6% lower HbA1c (95% CI 0.1, 1; p = 0.03). There was no evidence of an association between educational attainment and TIR/HbA1c. Conclusion Higher SES measured at an area level is associated with better achievement of glycaemic target using complementary measures of HbA1c and TIR in the GP-OSMOTIC cohort. Given that TIR may be more easily used in patient education and self-management support compared to HbA1c values, the social gradient identified in TIR provides an opportunity for clinicians and policy makers to address health inequities in T2D. Trial registration Australian and New Zealand Clinical Trials Registry Trial ACTRN12616001372471, prospective, Date registered 4/10/2016. |
| first_indexed | 2024-12-12T22:02:04Z |
| format | Article |
| id | doaj.art-80a6a448c2a24eda827f885308d2541b |
| institution | Directory Open Access Journal |
| issn | 1472-6823 |
| language | English |
| last_indexed | 2024-12-12T22:02:04Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Endocrine Disorders |
| spelling | doaj.art-80a6a448c2a24eda827f885308d2541b2022-12-22T00:10:30ZengBMCBMC Endocrine Disorders1472-68232018-07-011811710.1186/s12902-018-0279-6Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC studyMei Lyn Tan0Jo-Anne Manski-Nankervis1Sharmala Thuraisingam2Alicia Jenkins3David O’Neal4John Furler5Department of General Practice, University of MelbourneDepartment of General Practice, University of MelbourneDepartment of General Practice, University of MelbourneNHMRC Clinical Trials Centre, University of SydneyDepartment of Medicine, St Vincent’s Hospital, The University of MelbourneDepartment of General Practice, University of MelbourneAbstract Background Optimal glycaemia, reflected by glycated haemoglobin (HbA1c) levels, is key in reducing type 2 diabetes (T2D) complications. However, most people with T2D have suboptimal recall and understanding of HbA1c. Continuous glucose monitoring (CGM) measures glucose levels every 5 to 15-min over days and may be more readily understood. Given that T2D is more common in lower socioeconomic settings, we aim to study relationships between socioeconomic status (SES) and percentage time in glucose target range (TIR) which is a key metric calculated from CGM. Methods Analysis of baseline data from the General Practice Optimising Structured MOnitoring To Improve Clinical outcomes (GP-OSMOTIC) randomised controlled trial (October 2016 – November 2017) of 300 people with T2D from 25 Victorian General Practices. FreeStyle Libre Pro® sensor patch was used for this study. SES was defined by the Index of Relative Socio-economic Disadvantage (IRSD) and educational attainment. Univariable and multivariable mixed-effects linear regression analyses controlling for age, BMI, diet, exercise and study arm were performed. Results One hundred and sixty-seven (60.1%) participants were male, the mean (SD) participant age was 61.0 (9.7) years, and the mean (SD) duration of CGM use was 12.3 (2.5) days. The 10th IRSD decile (least disadvantaged) was associated with a 15% higher TIR vs. the 1st decile (most disadvantaged) (95% CI 5, 25; p = 0.003) and a 0.6% lower HbA1c (95% CI 0.1, 1; p = 0.03). There was no evidence of an association between educational attainment and TIR/HbA1c. Conclusion Higher SES measured at an area level is associated with better achievement of glycaemic target using complementary measures of HbA1c and TIR in the GP-OSMOTIC cohort. Given that TIR may be more easily used in patient education and self-management support compared to HbA1c values, the social gradient identified in TIR provides an opportunity for clinicians and policy makers to address health inequities in T2D. Trial registration Australian and New Zealand Clinical Trials Registry Trial ACTRN12616001372471, prospective, Date registered 4/10/2016.http://link.springer.com/article/10.1186/s12902-018-0279-6Type 2 diabetes mellitusPrimary careContinuous glucose monitorsTime in glucose target rangeSocioeconomic status |
| spellingShingle | Mei Lyn Tan Jo-Anne Manski-Nankervis Sharmala Thuraisingam Alicia Jenkins David O’Neal John Furler Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study BMC Endocrine Disorders Type 2 diabetes mellitus Primary care Continuous glucose monitors Time in glucose target range Socioeconomic status |
| title | Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study |
| title_full | Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study |
| title_fullStr | Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study |
| title_full_unstemmed | Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study |
| title_short | Socioeconomic status and time in glucose target range in people with type 2 diabetes: a baseline analysis of the GP-OSMOTIC study |
| title_sort | socioeconomic status and time in glucose target range in people with type 2 diabetes a baseline analysis of the gp osmotic study |
| topic | Type 2 diabetes mellitus Primary care Continuous glucose monitors Time in glucose target range Socioeconomic status |
| url | http://link.springer.com/article/10.1186/s12902-018-0279-6 |
| work_keys_str_mv | AT meilyntan socioeconomicstatusandtimeinglucosetargetrangeinpeoplewithtype2diabetesabaselineanalysisofthegposmoticstudy AT joannemanskinankervis socioeconomicstatusandtimeinglucosetargetrangeinpeoplewithtype2diabetesabaselineanalysisofthegposmoticstudy AT sharmalathuraisingam socioeconomicstatusandtimeinglucosetargetrangeinpeoplewithtype2diabetesabaselineanalysisofthegposmoticstudy AT aliciajenkins socioeconomicstatusandtimeinglucosetargetrangeinpeoplewithtype2diabetesabaselineanalysisofthegposmoticstudy AT davidoneal socioeconomicstatusandtimeinglucosetargetrangeinpeoplewithtype2diabetesabaselineanalysisofthegposmoticstudy AT johnfurler socioeconomicstatusandtimeinglucosetargetrangeinpeoplewithtype2diabetesabaselineanalysisofthegposmoticstudy |