The effect of insurance status and parental education on glycemic control and cardiovascular disease risk profile in youth with Type 1 Diabetes.

Shideh Majidi,Kim Mcfann,David M Maahs,Georgeanna J Klingensmith,R Paul Wadwa,Marian Rewers,Franziska K Bishop

doi:10.1186/2251-6581-13-59

Abstract

BackgroundAdult studies have shown a correlation between low socioeconomic status and Type 1 Diabetes complications, but studies have not been done in children to examine the effect of socioeconomic status on risk for future complications. This study investigates the relationship between insurance status and parental education and both glycemic control and cardiovascular disease (CVD) risk factors in youth with type 1 diabetes.MethodsA cross-sectional study of 295 youth with established type 1 diabetes who underwent examination with fasting blood draw and reported insurance status and parental education.ResultsYouth with type 1 diabetes and public insurance had higher hemoglobin A1c (HbA1c), body mass index, hs-CRP, and blood pressure (p < 0.05) than those with private insurance. Insulin regimen varied between insurance groups, and differences in HbA1c and CVD risk factors, except for diastolic blood pressure (DBP), were no longer evident after controlling for insulin regimen. Parental education was not associated with HbA1c or CVD risk factors.ConclusionsYouth with type 1 diabetes and public insurance have worse glycemic control and elevated CVD risk factors compared to those with private insurance, but this was no longer seen when insulin regimen was controlled for. Further research is needed to look at differences between those with public insurance and private insurance that contribute to differences in type 1 diabetes outcomes, and to identify modifiable risk factors in pediatric patients in order to focus earlier interventions to decrease and prevent future diabetes complications.

Highlights

Adult studies have shown a correlation between low socioeconomic status and Type 1 Diabetes complications, but studies have not been done in children to examine the effect of socioeconomic status on risk for future complications
Comparison by insurance status showed that children with private insurance were more likely to be nonHispanic white, have lower hemoglobin A1c (HbA1c), C-reactive protein (CRP), SBP, and diastolic blood pressure (DBP) (p < 0.05)
total cholesterol (TC), TG, and LDL-c levels were lower in children with private versus public insurance, but did not reach statistical significance

Summary

Introduction

Adult studies have shown a correlation between low socioeconomic status and Type 1 Diabetes complications, but studies have not been done in children to examine the effect of socioeconomic status on risk for future complications. This study investigates the relationship between insurance status and parental education and both glycemic control and cardiovascular disease (CVD) risk factors in youth with type 1 diabetes. Intensive glycemic control decreases rates of vascular complications [5], emphasizing the importance of early intensive diabetes management and modifiable factors that affect glycemic control and CVD risk. Lower socioeconomic status predicts worse glycemic control as well as increased rate of complications [6,7] and mortality [8]. In children with type 1 diabetes, lower socioeconomic status has been associated with worse glycemic control [10,11]. In studies showing an effect of parental education on glycemic control, it is often the father’s education level that is associated with glycemic control [15,16]

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