Socio economic disparities in the appropriateness of disease management of diabetes: results of AEQUITAS study

Background Hemoglobin HbA1c is a measure of blood glucose control and an indicator of the risk of developing diabetes complications. The number of HbA1c controls per year is an indicator of the appropriateness of disease management (DM). Diabetes guidelines recommend performing HbA1c test at least once a year. The aim of the study was to investigate the association between the number of HbA1c test per year and socioeconomic factors in a cohort of patients. Methods Data from a cross-sectional, multicenter Italian study (AEQUITAS), were used. General Practitioners (GPs) and administrative databases from the Regional Health Agency for the period 2003-2010 were investigated. All the diabetics in Marche Region who were in these GPs’ databases, were enrolled. Subjects’ level of education and the 2001 Italian Deprivation Index (IDI) at municipality level, were used as indicators of socioeconomic status. Descriptive statistics analyzed subjects according to education, age, gender and IDI. According to the yearly frequency of HbA1c test, subjects were grouped in 3 groups (≥2; ≥1 < 2; <1) and the association between demographic, socioeconomic and treatment variables were evaluated. Group comparisons were performed using Chi-square, Wilcoxon Mann Withney and Kruskall Wallis tests. A logistic regression was performed to ascertain the determinants of a poor (≤1 control per year) frequency of HbA1c measurements. The results were reported as Odds Ratios (OR) with 95% Confidence Intervals (CI). The R.2.15.3 software performed the statistics. Results Out of 4786 patients included in the study, 52.8% were males, 56.5% older than 65. Fifty four percent of the patients performed less than 1 HbA1c control per year. They frequently lived in a municipality with low IDI, were treated only with dietary change and stayed in the cohort for many years. The regression showed a protective effect of female gender (OR male 1,33 CI 1,17-1,53), between 65 and 74 years (OR 0,57 CI 0,37-0,87), who lived in a medium high – high IDI municipality (OR 0,63 CI 0,52-0,77), and were treated with oral hypoglycemizing drugs (OR 0,65 CI 0,44- 0,98). Conclusions Subjects aged 65 to 74 years, not receiving drugs and living in deprived municipalities are vulnerable for a worse quality of diabetes DM. Key message This paper gives evidence of disparities in the appropriateness diabetes disease management. Medical primary care plays a pivotal role for monitoring and reducing these inequalities.