The relationship between socioeconomic status and diabetes control and complications in the EURODIAB IDDM complications study

OBJECTIVE - To determine whether there are socioeconomic differences in diabetes control and complications in people with IDDM. RESEARCH DESIGN AND METHODS - We conducted a prevalence survey of 1,217 men and 1,170 women with IDDM age 25-60 years from 31 European clinics. Age at completion of education defined socioeconomic status: less than or equal to 14 years defined those with primary education, 15-18 years, as secondary education; and > 19 years, as college education. Glycemic control, lipids, diet, retinopathy, nephropathy, and heart disease were assessed centrally. RESULTS - People with a primary education were older and had diabetes for longer than those with a college education. The mean percentage of HbA(1c) was worst in the primary-educated men (6.6 vs. 6.1%, P = 0.0007 for trend) and women (6.5 vs. 6.0%, P = 0.0007). Total cholesterol level was higher in primary-educated than in college-educated men (5.6 vs. 5.3 mmol/l, P = 0.002), as was triglyceride level(1.23 vs. 1.02 mmol/l, P = 0.0001). College-educated people were the least likely to be current smokers (P < 0.0001), and were most likely to partake in vigorous exercise (P < 0.001). Surprisingly, there was little difference in the prevalence of heart disease by educational status in men, while ii was highest in the least educated women, but proliferative retinopathy was more common in primary- than in college-educated men (16 vs. 10%, P = 0.04) as was macroalbuminuria (15 vs. 9%, P = 0.03). Glycemic control could not fully account for these differences. CONCLUSIONS - Healthy lifestyles are more prevalent in better educated men and women with IDDM, but these are not reflected in heart disease prevalence in men. The lower prevalence of severe microvascular complications in better educated men, unaccounted for by better glycemic control, requires further investigation.