The aim of this study was to analyze socioeconomic position (SEP) inequalities in the prevalence and incidence of type 2 diabetes mellitus (T2DM) in people aged 50 years and over in Europe and to describe the contribution of body mass index (BMI) and other possible mediators. This was a cross-sectional and longitudinal study including men and women ≥ 50 years old in 11 European countries in 2004 and 2006 (n = 21,323). The prevalence and cumulative incidence of T2DM were calculated with self-reported T2DM or when the individual took drugs for diabetes. Prevalence ratio (PR) and relative risk (RR) of prevalent and incident T2DM were calculated according to educational level and adjusted by BMI and other possible mediators. The age-adjusted and country-adjusted prevalence of T2DM in 2004 was 10.2% in men and 8.5% in women. Compared to those with higher education, men and women with lower education had a PR [95% CI] of T2DM of 1.29 [1.12-1.50] and 1.61 [1.39-1.86], respectively. SEP-related inequalities in incidence (RR [95%CI]) were 1.88 [1.35-2.62] in women and 1.04 [0.78-1.40] in men. Adjusting for potential mediators reduced inequalities in the prevalence and incidence of T2DM among women by 26.2% and 21.6%, respectively, and inequalities in prevalence among men by 44.8%. We observed significant inequalities in the prevalence and incidence (women only) of T2DM as a function of socioeconomic position. These inequalities were mediated by BMI.

Background People in a lower social position have a higher prevalence of unhealthy behaviour, more difficult access to healthcare, and lower compliance with drug treatment; as a consequence, social differences in mortality are likely to be higher in people with diabetes compared with the non-diabetic population. We compared diabetics with non-diabetics in terms of mortality and social differences in mortality. Methods In all, 31 264 residents in Turin (northern Italy), who were ≥20 years old, registered in the local diabetes register between 1991 and 1999. They were followed up from recruitment to December 1999, and their cause-specific mortality by educational level was analysed. This was compared with that of the local non-diabetic population. Diabetes was classified as type 1 (≤35 years at diagnosis) or type 2 (>35 years). Results For type 1 diabetes, the all-cause standardized mortality ratio (SMR) was 197.6 (95% CI:155.7, 247.4) in men and 336.0 (95% CI:259.3, 428.2) in women; for type 2 diabetes, the all-cause SMR was 142.8 (95% CI:138, 147.6) in men and 143.4 (95% CI:138.5, 148.5) in women. Whereas social differences in mortality were evident among non-diabetic men and women for all causes of death considered, no significant differences were found among diabetic women. Mortality was slightly increased among less educated diabetic men, particularly for neoplasms, although this gradient was less steep than that among non-diabetics. Conclusions These results suggest that the regular clinical follow-up and health education provided by the local network of diabetic centres might play an important role in confronting the adverse effects of diabetes and in reducing social differences in health.

OBJECTIVE: To investigate the role of clinical and socioeconomic variables as determinants of adherence to recommended diabetes care guidelines and assess differences in the process of care between diabetologists and general practitioners. RESEARCH DESIGN AND METHODS: We identified diabetic residents in Torino, Italy, as of 31 July 2003, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations registered during the subsequent 12 months and performed regression analyses to identify associations with quality-of-care indicators based on existing guidelines. RESULTS: After 1 year, only 35.8% of patients had undergone a comprehensive assessment. In the multivariate models, factors independently and significantly associated with lower quality of care were age ≥75 years (prevalence rate ratio [PRR] 0.66 [95% CI 0.61–0.70]) and established cardiovascular disease (0.89 [0.86–0.93]). Disease severity (PRR for insulin-treated patients 1.45 [1.38–1.53]) and diabetologist consultation (PRR 3.34 [3.17–3.53]) were positively associated with high quality of care. No clear association emerged between sex and socioeconomic status. These differences were strongly reduced in patients receiving diabetologist care compared with patients receiving general practitioner care only. CONCLUSIONS: Despite widespread availability of guidelines and simple screening procedures, a nonnegligible portion of the diabetic population, namely elderly individuals and patients with less severe forms of the disease, are not properly cared for. As practitioners in diabetes centers are more likely to adhere to guidelines than general practitioners, quality in the diabetes care process can be improved by increasing the intensity of disease management programs, with greater participation by general practitioners.