Inequalities in glycaemic control, hypoglycaemia and diabetic ketoacidosis according to socio‐economic status and area‐level deprivation in Type 1 diabetes mellitus: a systematic review

摘要

Abstract Aim The aim of this systematic review was to examine the associations of individual‐level as well as area‐level socio‐economic status and area‐level deprivation with glycaemic control, hypoglycaemia and diabetic ketoacidosis in people with Type 1 diabetes mellitus. Methods Ovid MEDLINE was searched to identify relevant cohort, case‐control or cross‐sectional studies published between January 2000 and June 2015. Search results were screened by title, abstract and keywords to identify eligible publications. Decisions on inclusion or exclusion of full texts were made independently by two reviewers. The Newcastle‐Ottawa Scale was used to estimate the methodological quality of included studies. Quality assessment and extracted data of included studies were synthesized narratively and reported according to the PRISMA statement. Results Literature search in Ovid MEDLINE identified 1345 eligible studies. Twenty studies matched our inclusion and exclusion criteria. Two articles were additionally identified through hand search. According to the Newcastle‐Ottawa Scale, most of the studies were of average quality. Results on associations of socio‐economic status and area‐level deprivation with glycaemic control and hypoglycaemia were contradictory between studies. By contrast, lower socio‐economic status and higher area‐level deprivation were associated with a higher risk for diabetic ketoacidosis in all except one study. Conclusions Lower socio‐economic status and higher area‐level deprivation are associated with a higher risk of experiencing diabetic ketoacidosis in people with Type 1 diabetes mellitus. Access to care for socially deprived people needs to be expanded to overcome impairing effects on the course of the condition and to reduce healthcare disparities.