Socioeconomic Status and Obesity in Patients with Diabetes

Are socioeconomic factors and obesity independently related to diabetes prevalence?

This study explores the connection between socioeconomic status and the prevalence of diabetes and determines if it is arbitrated by a patient’s body mass index ranking. For this particular study, diabetes was defined as self-reported fasting glucose of greater than or equal to 126 mg/dL or hemoglobin A1C greater than or equal to 6.5%, or the use of glucose-lowering medications. Obesity was defined as a body mass index of greater than or equal to 30 kg/m2. The socioeconomic status was measured based on educational level split into three categories: 1st degree, 2nd degree, and 3rd degree or higher, and monthly income divided into three types of less than 900 euros, between 900-1700 euros, and greater than 1700 euros. 

For this particular cross-sectional analysis study, the objective was to determine if socioeconomic factors and obesity are independently related to developing diabetes prevalence. The study population consisted of adults greater than or equal to 18 years of age from Greece, where there is a rising number of diabetes patients in the last decades. The essential inclusion criteria were for all patients to have their fasting blood glucose or hemoglobin A1c levels readily available. In addition, the study examined the related risk factors like health care and preventative actions utility repetitions in a random sample of adults to describe death caused by cardiovascular disease and diabetes. There were no differences between men and women in the subset groups. The data for this study was compiled for surveys conducted from May 2013 to June 2016. The initial total sample size was 6,006 adult patients. Only 5,993 patients had known age and gender, and 4,393 patients had their fasting blood glucose or hemoglobin A1c measurements accessible. This study chose the sample size by implementing multistage stratified randomization on the 2011 census. The researchers used a weighted logistic regression model to regulate factors. An inverse probability weighting method was used to account for the differences in people with available fasting blood glucose or hemoglobin A1c levels and those without

The results implicated that the overall diabetes prevalence was 11.9% (CI: 10.0-12.9). The data showed that the more education and income a patient had, the lower the prevalence of diabetes. The relation between obesity and the educational p-value was less than 0.001, and the monthly family income p-value was 0.0174. Also, it was concluded that patients with either overweight or obesity did have a significantly higher chance of developing diabetes. Association between diabetes, gender, degree of urbanization, family history of diabetes, and dyslipidemia was also explored. Based on multivariable analysis, it was determined that older patients had an increased prevalence of diabetes. Women who lived in rural areas had a lower prevalence of diabetes than women living in urban areas. Also, most diabetes was higher in patients who had either a family history of diabetes or dyslipidemia.                                      

In conclusion, the prevalence of diabetes increases with increasing age and body mass index, and it decreases with higher educational levels and family monthly income. However, measures like food insecurities and physical checks were not significant after the factors were adjusted. Therefore, a patient’s body mass index does not entirely explain the connection between socioeconomic status and diabetes prevalence. 

Practice Pearls:

• It can be concluded that diabetes prevalence is, in fact, independently related to low socioeconomic status in patients who live in Greece. 
• More involvement in the prevention of diabetes, focusing on obesity, should be done for patients who have a low education level and low monthly income. 
• Male sex was determined to be connected to a higher prevalence of diabetes.

Liatis S, Sotiropoulos S, Ioannidis I, et al. Socioeconomic factors and obesity: Are they independently associated with the prevalence of diabetes? EASD Virtual Congress. Published 2020. Accessed October 11, 2020.

Alexandria Bartley, PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences