ORIGINAL ARTICLE Influence of Socio-Economic and Cultural Factors on Type 1 Diabetes Management: Report from a Tertiary Care Multidisciplinary Diabetes Management Center in India Pragya Mangla 1 & Suchit Gupta 1 & Aditi Chopra 1 & Vijayalakshmi Bhatia 1 & Ruchira Vishwakarma 1 & Pranjul Asthana 1 Received: 19 August 2019 /Accepted: 29 January 2020 # Dr. K C Chaudhuri Foundation 2020 Abstract Objective To study the association of socio-economic (SE) and cultural factors with HbA1c and diabetes knowledge of children, adolescents and young adults with T1DM managed in the authors' centre, as these may be unique to a country or a region. Methods Demographic details, SE scoring, body mass index and mean of the last two HbA1c values were recorded, in 173 eligible patients. A diabetes knowledge test (DKT) was administered. Results Median (range) age was 14.0 (3.25–25.5) y and HbA1c 8.2 ± 1.3%. The patients travelled a median of 124 (range 0.5– 850) km and 2.3 (range 0.1–18.3) h each way, to reach the clinic. Only 2 children took insulin at school / college. Insulin adjustment for pre-meal blood glucose was practiced by 88%, but adjustment for meal intake by only 17% patients. Median HbA1c was lower in the participants with age > 18 y [7.7 (5.6–11.0) %] vs. < 10 y [8.3 (6.3–10.6) %, p < 0.02] or 10–18 y [(8.3 (5.9–12.6) %, p < 0.02)]. Overweight /obesity were seen in 35%. On multivariate regression, HbA1c was associated negatively with DKT score (DKTS) and age group, and DKTS was associated positively with urban residence and maternal education > class 12th. HbA1c and DKTS were not associated with income. Conclusions Low income may be successfully compensated by other factors to obtain good glycemic control. HbA1c did not deteriorate in adolescence in contrast to world experience. Overweight is a worrisome problem. Improved societal awareness about childhood diabetes is crucial. Keywords Maternal education . HbA1c . Income . Obesity . Overweight . Diabetes knowledge Introduction Type 1 diabetes mellitus (T1DM) is a chronic disorder asso- ciated with significant long term complications. Glycemic control, as reflected by HbA1c, is a strong predictor of these long-term complications [1]. Apart from factors related to poor adherence to the diabetes regimen, socio-economic (SE) and family demographic factors like SE class, maternal education and knowledge, rural residence and distance from the clinic, among others, have been reported to have an effect on HbA1c [2–11]. India has a heterogeneous cultural and SE composition, with an inadequate social security system. Multidisciplinary diabetes management centers are few and therefore patients may need to travel long distances to avail of such facilities. All these factors must be addressed if the benefit of modern knowledge is to reach our families with T1DM. The diabetes clinic at the authors' hospital is a part of a government funded tertiary care referral center in the northern part of India which gets its patients from all socioeconomic strata, primarily from Uttar Pradesh, Bihar and Madhya Pradesh. This study was planned to evaluate the effect of various socio-economic and cultural factors on glycemic control of children, adolescents and young adults with T1DM in the authors' clinic. Material and Methods Consecutive patients with T1DM, 3–26 y in age (or earlier if he/she has left the parental home), attending the OPD for * Vijayalakshmi Bhatia bhatiaviji@gmail.com 1 Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India The Indian Journal of Pediatrics https://doi.org/10.1007/s12098-020-03227-w