Socioeconomic deprivation, technology use, C-peptide, smoking and other predictors of glycaemic control in adults with type 1 diabetes.

Abstract

Intensive glycaemic control is associated with substantial health benefits in people with type 1 diabetes. We sought to examine clinical and demographic factors associated with meeting glycaemic targets in type 1 diabetes. We conducted a cross-sectional analysis of 4594 individuals with type 1 diabetes. The primary outcome of the study was assessing factors associated with meeting HbA1c targets. Secondary endpoints included factors associated with continuous subcutaneous insulin infusion (CSII) use and persistent C-peptide secretion. Socioeconomic deprivation was strongly associated with a lower likelihood of achieving an HbA1c <58mmol/mol (7.5%) (20% in the most deprived quintile vs. 40% in the least deprived, p<0.001). In multivariate analysis, absence of smoking history (OR 3.06, p<0.001), flash monitoring (OR 1.49, p<0.001), CSII (1.43, p=0.022) and longer diabetes duration (OR 1.02 per year, p=0.004) were independently associated with achieving HbA1c <58mmol/mol (7.5%), whereas increasing age (OR 0.99 per year, p=0.004) and C-peptide <50pM (OR 0.58, p<0.001) were associated with a lower likelihood of meeting this target. Low C-peptide (<50pM) was less likely in men (OR 0.55, p<0.001) and never smokers (0.44, p<0.001) in multivariate analysis. Lower levels of deprivation, non-smoking, higher C-peptide, technology use, lower BMI and male gender were all associated with a higher likelihood of meeting HbA1c targets. Access to proven diabetes treatments is lower in the most deprived individuals. Urgent efforts are required to provide treatments which are effective across the socioeconomic gradient.