AUTHOR=Gomes Marília B. , Tang Fengming , Chen Hungta , Cid-Ruzafa Javier , Fenici Peter , Khunti Kamlesh , Rathmann Wolfgang , Shestakova Marina V. , Surmont Filip , Watada Hirotaka , Medina Jesús , Shimomura Iichiro , Saraiva Gabriela Luporini , Cooper Andrew , Nicolucci Antonio 

TITLE=Socioeconomic Factors Associated With Glycemic Measurement and Poor HbA1c Control in People With Type 2 Diabetes: The Global DISCOVER Study

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.831676

DOI=10.3389/fendo.2022.831676

ISSN=1664-2392

ABSTRACT=DISCOVER is a 3-year observational study program of 15,983 people with type 2 diabetes initiating second-line glucose-lowering therapy in 38 countries. We investigated the association between socioeconomic status and both the availability of a baseline glycated hemoglobin (HbA1c) measurement and poor glycemic control (HbA1c level ≥ 9.0%) in participants enrolled in DISCOVER. Factors associated with a lack of baseline HbA1c measurement or an HbA1c level ≥ 9.0% were assessed using three-level hierarchical logistic models. Overall, 19.1% of did not have a baseline HbA1c measurement recorded. Low country income and low educational level were independently associated with having a missing baseline HbA1c measurement. Of the participants with an available HbA1c measurement, 26.9% had a HbA1c level ≥ 9.0%; 68.7% of these individuals were from lower- or upper-middle-income countries. Factors associated with an increased likelihood of poor glycemic control included low country income, treatment at a site with public and/or governmental funding (vs. private funding) and having public or no health insurance (vs. private). A substantial proportion of DISCOVER participants did not have an HbA1c measurement; more than one-quarter of these participants have poorly controlled type 2 diabetes. Both individual- and country-level socioeconomic factors affect the quality of care regarding glycemic control.