Pediatric Endocrine Group
Factors such as socioeconomic status, education and family structure
influence glycemic control in pediatric patients with type 1 diabetes, data
from a poster presented at the Canadian Pediatric Endocrine Group 2012
Scientific Meeting suggest.
Despite universal access to health care, investigators at the Hospital
for Sick Children in Toronto found some segments of their patient population
had better HbA1c control than others, according to Farid H. Mahmud, MD,
FRCPC, a pediatric endocrinologist at the Hospital for Sick Children and an
assistant professor at the University of Toronto.
Farid H. Mahmud
“Social determinants of health impact our patients,”
Mahmud told Endocrine Today, describing the patient population in his pediatric
diabetes clinic as diverse.
Mahmud and pediatric endocrine research fellow Caroline Zuijdwijk,
MD,FRCPC, de-identified patient postal code information and linked
it to established indices of material and social deprivation, which are
validated measures based on 2006 Canadian Census data. The material deprivation
index is a marker of education and socioeconomic status, and the social
deprivation index is a measure of family structure. They also looked at ethnic
concentration from the Ontario Marginalization Index (ON-Marg). Each index is
reported as a quintile score (1st quintile: least deprived, and 5th quintile:
most deprived) for each dissemination area (smallest geographic area for which
census data is disseminated) in Canada.
Mean patient HbA1c values were examined and related to quintile scores
for three indices, including material deprivation index, social deprivation
index and ethnic concentration.
They found that HbA1c values are associated with all three indices (1st
vs. 5th quintile), including material deprivation (8.3% vs. 8.9%,
P≤.0001), social deprivation (8.4% vs. 8.8%, P=.0156) and
ethnic concentration (8% vs. 8.8%, P=.0003).
The quintile that was the least socioeconomically advantaged had the
highest HbA1c level, whereas the most socioeconomically advantaged quintile had
the lowest HbA1c level, Mahmud said, adding that the effect of income
disparities is evident in his pediatric
“Our conclusion is that we need to do more,” Mahmud said.
“We want to design ways to overcome inequities. Our next step is
[developing] targeted interventions for those at highest risk.”
Gillian Booth, MD, FRCPC, an adult endocrinologist at St.
Michael’s Hospital in Toronto, an associate professor in the department of
medicine at the University of Toronto and an adjunct scientist at the Institute
for Clinical Evaluative Sciences, said the findings are significant.
“The study shows there is a difference in glycemic control in
children who live in materially deprived areas,” said Booth, who has
published data on the relationship between socioeconomic status and acute
complications of diabetes in Ontario. Her data demonstrated that those in the
lowest income quintile were 44% more likely to experience a hospitalization or
ED visit than those in the highest quintile.
Booth recommended interventions to target populations at higher risk for
poor glycemic control.
For more information:
Disclosure: Drs. Mahmud and Booth report no relevant financial