CLINICAL IMPLICATIONS OF LOW SOCIAL INTEGRATION IN TYPE 1 DIABETES
P. Pedrianes-Martín, I. Peiró-Martínez, H. Rodríguez-Rosas, F.J. Martínez-Martín
Endocrinology Dpt., University Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain
Objectives: The treatment of type 1 diabetes mellitus is too often unsuccessful due to reasons that are not purely medical; among them social marginality seems to be critical, but few studies have attempted to quantify its impact. We sought to assess, in a type 1 diabetic patient population attended in an outpatient clinic, the relationship of social integration with:
-the compliance with diet, exercise, self glucose monitoring and insulin injections.
-the implementation of intensive insulin treatment (> 3 injections/day).
-the control of diabetes (mean HbA1c, rates of hypoglycemia and acute hyperglycemia).
-the presence of metabolic comorbidities (obesity, hypertension, dyslipidaemia).
-the presence of diabetic complications (retinopathy, ophthalmopathy, neuropathy).
Methods: Of 357 consecutive patients with type 1 diabetes mellitus who attended our outpatient clinic, 23 (6%) refused to participate; the data were obtained by a validated questionnaire from the rest of the subjects (N = 334), including: age, gender, cultural, marital and financial status, self-reported adherence to glucose monitoring and treatment, and participation in 12 types of social events (private parties, large family gatherings, night entertainment activities, outdoor sporting events, movies/theatre events or forums, public religious events, demonstrations, labor union meetings, art exhibitions, cultural associations, study circles or courses, meetings of other organizations); the data on intensive treatment, diabetes control, comorbidities and complications were obtained from the clinical records.
Results: The social integration of 122 subjects (36.5%) was categorized as “low” because they had participated in three or less of the listed events in the last three months.
A logistic regression analysis including low social integration as the dependent variable, and all other variables as independent showed that: low cultural and financial status; single or divorced marital status, low adherence to diet, exercise and self glucose monitoring; high mean HbA1c, high rate of severe hypoglycemia; presence of obesity, hypertension and dyslipidaemia; and presence of retinopathy and ophthalmopathy, were significantly and independently associated with low social integration (p < 0.05, SPSS v.15). On the contrary, age, gender, adherence to insulin injection, rate of acute hyperglycemic complications and presence of diabetic neuropathy were not significantly related to social integration.
Discussion: In our type 1 diabetic population many variables implied in unsuccessful treatment (non-intensive treatment, low adherence to diet, exercise and self-monitoring; high HbA1c, high rate of severe hypoglycemia, most diabetic comorbidities and complications) were associated with low social integration, estimated by low participation in a variety of social events. Our study underscores the importance of psychosocial factors in type 1 diabetes treatment, but unfortunately these factors are too often neglected.