SOCIAL DISPARITIES IN DIABETES CARE: A GENERAL POPULATION STUDY IN DENMARK

Objective. The objective of this study was to describe how socio-demographic factors are associated with the pharmacotherapy and achievement of goals for diabetes care in patients with Type 2 Diabetes Mellitus (T2DM). Design. Cross-sectional population study. Setting. Denmark, Naestved municipality. Subjects. Patients with known T2DM (n907) within a random sample of 21,198 citizens. Outcome. Fraction of patients not achieving goals for diabetes care on: HbA1c and LDL-cholesterol, Blood Pressure (BP) and lifestyle measures. Secondary outcome: Treatment with antihypertensive, glucose- and cholesterol-lowering medication. We investigated the association between outcomes and socio-demographic factors: age, gender, income, level of education, civil status, employment, and cardiovascular disease (CVD). Results: Poor diabetes control was associated with middle-aged, low income and low level of education. The sub-group with T2DM and CVD attained treatment goals similar to the total patient sample. Men achieved goals for LDL-cholesterol and physical activity to a higher degree than women, but were less well regulated on HbA1c. Only a minority, of the patients with T2DM were well regulated and reported a lifestyle according to international recommendations. Low socioeconomic status (SES) was not associated with lower levels of pharmacological treatment, rather the contrary. Conclusion The socio-demographic gradient in achievement of treatment goals for diabetes care is eminent even in a country with universal health coverage and reimbursement of medical expenses, especially for lifestyle measures. Low SES was associated with same or more extensive utilization of antihypertensive, cholesterol- and glucose-lowering medication.