Association Among Individual Deprivation, Glycemic Control, and Diabetes Complications The EPICES score H´ EL ` ENE BIHAN, MD 1 SILVANA LAURENT, MD 1 CATHERINE SASS, MD 2 G´ ERARD NGUYEN, MD 1 CAROLINE HUOT, MD 1 JEAN JACQUES MOULIN, MD 2 REN´ E GUEGEN, MD 2 PHILIPPE LE TOUMELIN, MD 3 HERV´ E LE CL ´ ESIAU, MD 4 EMILIO LA ROSA, MD 4 G´ ERARD REACH, MD 1 R´ EGIS COHEN, MD 1 OBJECTIVE — Previous studies have related poor glycemic control and/or some diabetes complications to low socioeconomic status. Some aspects of socioeconomic status have not been assessed in these studies. In the present study, we used an individual index of deprivation, the Evaluation de la Pre ´carite ´ et des Ine ´galite ´ s de sante ´ dans les Centres d’Examens de Sante ´ (Eval- uation of Precarity and Inequalities in Health Examination Centers [EPICES]) score, to determine the relationship among glycemic control, diabetes complications, and individual conditions of deprivation. RESEARCH DESIGN AND METHODS — We conducted a cross-sectional prevalence study in 135 consecutive diabetic patients (age 59.41  13.2 years [mean  SD]) admitted in the hospitalization unit of a French endocrine department. Individual deprivation was assessed by the EPICES score, calculated from 11 socioeconomic questions. Glycemic control, lipid levels, blood pressure, retinopathy, neuropathy, and nephropathy were assessed. RESULTS — HbA 1c level was significantly correlated with the EPICES score (r = 0.366, P  0.001). The more deprived patients were more likely than the less deprived patients to have poor glycemic control (= 1.984 [SE 0.477], P  0.001), neuropathy (odds ratio 2.39 [95% CI 1.05–5.43], P = 0.037), retinopathy (3.66 [1.39 –9.64], P = 0.009), and being less often admitted for 1-day hospitalization (0.32 [0.14 – 0.74], P = 0.008). No significant relationship was observed with either nephropathy or cardiovascular risk factors. CONCLUSIONS — Deprivation status is associated with poor metabolic control and more frequent microvascular complications, i.e., retinopathy and neuropathy. The medical and eco- nomic burden of deprived patients is high. Diabetes Care 28:2680 –2685, 2005 A ccumulated evidence has demon- strated that achievement of near- normal glycemic control in diabetes care reduces the development and pro- gression of microvascular complications (1,2). This approach is also cost-effective compared with other treatments (3). As a chronic disease, diabetes needs specific self-management care and adherence to treatment. Therefore, poor socioeco- nomic conditions could influence the outcome of diabetic patients. Increased mortality has also been reported in rela- tion to socioeconomic status (4 –7). Some studies have reported a higher prevalence of poor glycemic control and/or compli- cations in patients with low socioeco- nomic status (8). In these studies, socioeconomic status has been assessed by several indicators that may represent different dimensions of the socioeco- nomic status (9), i.e., occupation (10), ed- ucation (11,12), income (12), or area deprivation (13). Instead of being inter- changeable determinants of health, stud- ies have shown that these indicators are independent and partially interdepen- dent determinants of health (8,14,15). Socioeconomic status also encompasses other dimensions such as social support and relationships, childhood/adult life events, and accommodation status. Tradi- tional socioeconomic indicators are not always a good means to assess the socio- economic status or deprivation of an in- dividual in its full dimension. It has also been proposed that different approaches to the assessment of socioeconomic status are necessary to have a fuller picture of the relationship between socioeconomic sta- tus and health (8). Therefore, the aim of the present study was to assess the asso- ciation among glycemic control, diabetes complications, and an individual score of deprivation that takes into account the multiple dimensions of socioeconomic conditions including psychological, so- cial, and economic aspects. RESEARCH DESIGN AND METHODS — We conducted a cross- sectional study in the endocrinology unit of Avicenne Hospital in 2000. During a 6-week period, 135 consecutive diabetic patients were included. Only 123 patients (91%) completed the form. Fifty-one were admitted for conventional hospital- ization and 72 for 1-day hospitalization. For each patient a medical report indicat- ing all the characteristics of the disease was available. Type 1 diabetes was de- ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● From the 1 Universite ´ Paris XIII (CRNH) et Services de Me ´decine Interne et d’Endocrinologie, de l’Ho ˆ pital Avicenne, Bobigny, France; 2 Cetaf, Centre Technique d’Appui et de Formation des Centres d’Examens de Sante ´, Saint-Etienne, France; the 3 Service d’Information Me ´dicale et Statistique de l’Ho ˆ pital Avicenne, Bobigny, France; and the 4 Centre de Pre ´vention Sanitaire et Sociale de Seine Saint Denis, Bobigny, France. Address correspondence and reprint requests to Dr. Re ´ gis Cohen, Ho ˆ pital Avicenne, Service de Me ´decine Interne et d’Endocrinologie, 93009 Bobigny Cedex, France. E-mail: regis.cohen@avc.aphp.fr. Received for publication 1 April 2005 and accepted in revised form 20 July 2005. Abbreviations: EPICES, Evaluation de la Pre ´carite ´ et des Ine ´galite ´ s de sante ´ dans les Centres d’Examens de Sante ´ (Evaluation of Precarity and Inequalities in Health Examination Centers); UKPDS, U.K. Prospective Diabetes Study. A table elsewhere in this issue shows conventional and Syste `me International (SI) units and conversion factors for many substances. © 2005 by the American Diabetes Association. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E 2680 DIABETES CARE, VOLUME 28, NUMBER 11, NOVEMBER 2005 Downloaded from http://diabetesjournals.org/care/article-pdf/28/11/2680/568274/zdc01105002680.pdf by guest on 02 June 2022