The Influence of Age, Sex, and Socioeconomic Status on Glycemic Control Among People With Type 1 and Type 2 Diabetes in Canada: Patient-Led Longitudinal Retrospective Cross-sectional Study With Multiple Time Points of Measurement

Seyedmostafa Mousavi; Dana Tannenbaum Greenberg; Ruth Ndjaboué; Michelle Greiver; Olivia Drescher; Selma Chipenda Dansokho; Denis Boutin; Jean-Marc Chouinard; Sylvie Dostie; Robert Fenton; Marley Greenberg; Jonathan McGavock; Adhiyat Najam; Monia Rekik; Tom Weisz; Donald J Willison; Audrey Durand; Holly O Witteman; Diabetes Action Canada Research Questions Prioritization Study

doi:10.2196/35682

The Influence of Age, Sex, and Socioeconomic Status on Glycemic Control Among People With Type 1 and Type 2 Diabetes in Canada: Patient-Led Longitudinal Retrospective Cross-sectional Study With Multiple Time Points of Measurement

JMIR Diabetes. 2023 Apr 27:8:e35682. doi: 10.2196/35682.

Authors

Seyedmostafa Mousavi^{1

2

3}, Dana Tannenbaum Greenberg¹, Ruth Ndjaboué^{1

4

5}, Michelle Greiver^{1

6

7}, Olivia Drescher¹, Selma Chipenda Dansokho^{1

8}, Denis Boutin^{1

9}, Jean-Marc Chouinard¹, Sylvie Dostie¹, Robert Fenton^{1

10}, Marley Greenberg¹, Jonathan McGavock^{1

11}, Adhiyat Najam¹, Monia Rekik^{1

12

13

14}, Tom Weisz^{1

15

16}, Donald J Willison^{1

17}, Audrey Durand^{18

19

20

21}, Holly O Witteman^{1

2

8

22}; Diabetes Action Canada Research Questions Prioritization Study²³

Collaborators

Diabetes Action Canada Research Questions Prioritization Study:
Lahssen Abbassi, Javed Alloo, André Amyot, Elaine Brière, Stéphane Brière, Sasha Delorme, Lanie Deslauriers, Sophie Desroches, Maman Joyce Dogba, Noah M Ivers, Tania Leclerc, Alex M McComber, Danièle Remy, Larry Spence, Nadia Tabiou, Frank Tang, Joshua Tepper, Marie-Claude Tremblay, David Wells, Catherine Yu

Affiliations

¹ Diabetes Action Canada, Toronto, ON, Canada.
² VITAM Research Centre in Sustainable Health, Québec, QC, Canada.
³ Université Laval, Québec, QC, Canada.
⁴ Centre de recherche sur le Vieillissement, Sherbrooke, QC, Canada.
⁵ School of Social Work, Faculty of Letters and Human Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada.
⁶ Department of Family and Community Medicine, North York General Hospital, Toronto, ON, Canada.
⁷ Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁸ Office of Education and Professional Development, Faculty of Medicine, Université Laval, Québec, QC, Canada.
⁹ Centre de recherche du CHUS, Sherbrooke, QC, Canada.
¹⁰ National Indigenous Diabetes Association, Winnipeg, MB, Canada.
¹¹ Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
¹² Department of Operations and Decision Systems, Faculty of Business Administration, Université Laval, Québec, QC, Canada.
¹³ Cardiometabolic Health, Diabetes and Obesity Research Network (CMDO), Sherbrooke, QC, Canada.
¹⁴ Interuniversity Research Centre of Enterprise Networks (CIRRELT), Montréal, QC, Canada.
¹⁵ Wounds Canada, North York, ON, Canada.
¹⁶ Diabetes Canada, Toronto, ON, Canada.
¹⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹⁸ Canada CIFAR AI Chair, Québec, QC, Canada.
¹⁹ Institute Intelligence and Data, Université Laval, Québec, QC, Canada.
²⁰ Department of Computer Science and Software Engineering, Faculty of Science and Engineering, Université Laval, Québec, QC, Canada.
²¹ Department of Electrical Engineering and Computer Engineering, Faculty of Science and Engineering, Faculty of Science and Engineering, Québec, QC, Canada.
²² Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.
²³ See Acknowledgments, .

PMID: 37104030
PMCID: PMC10176138
DOI: 10.2196/35682

Abstract

Background: Clinical guidelines for most adults with diabetes recommend maintaining hemoglobin A_1c (HbA_1c) levels ≤7% (≤53 mmol/mol) to avoid microvascular and macrovascular complications. People with diabetes of different ages, sexes, and socioeconomic statuses may differ in their ease of attaining this goal.

Objective: As a team of people with diabetes, researchers, and health professionals, we aimed to explore patterns in HbA_1c results among people with type 1 or type 2 diabetes in Canada. Our research question was identified by people living with diabetes.

Methods: In this patient-led retrospective cross-sectional study with multiple time points of measurement, we used generalized estimating equations to analyze the associations of age, sex, and socioeconomic status with 947,543 HbA_1c results collected from 2010 to 2019 among 90,770 people living with type 1 or type 2 diabetes in Canada and housed in the Canadian National Diabetes Repository. People living with diabetes reviewed and interpreted the results.

Results: HbA_1c results ≤7.0% represented 30.5% (male people living with type 1 diabetes), 21% (female people living with type 1 diabetes), 55% (male people living with type 2 diabetes) and 59% (female people living with type 2 diabetes) of results in each subcategory. We observed higher HbA_1c values during adolescence, and for people living with type 2 diabetes, among people living in lower income areas. Among those with type 1 diabetes, female people tended to have lower HbA_1c levels than male people during childbearing years but higher HbA_1c levels than male people during menopausal years. Team members living with diabetes confirmed that the patterns we observed reflected their own life courses and suggested that these results be communicated to health professionals and other stakeholders to improve the treatment for people living with diabetes.

Conclusions: A substantial proportion of people with diabetes in Canada may need additional support to reach or maintain the guideline-recommended glycemic control goals. Blood sugar management goals may be particularly challenging for people going through adolescence or menopause or those living with fewer financial resources. Health professionals should be aware of the challenging nature of glycemic management, and policy makers in Canada should provide more support for people with diabetes to live healthy lives.

Keywords: adolescent; adult; co-design; cohort studies; diabetes mellitus; diabetes mellitus type 1; diabetes mellitus type 2; glycated hemoglobin; menopause; participatory medicine; patient engagement; postmenopause; premenopause; public and patient involvement; sex factors; socioeconomic disparities in health; user design.

©Seyedmostafa Mousavi, Dana Tannenbaum Greenberg, Ruth Ndjaboué, Michelle Greiver, Olivia Drescher, Selma Chipenda Dansokho, Denis Boutin, Jean-Marc Chouinard, Sylvie Dostie, Robert Fenton, Marley Greenberg, Jonathan McGavock, Adhiyat Najam, Monia Rekik, Tom Weisz, Donald J Willison, Audrey Durand, Holly O Witteman, Diabetes Action Canada Research Questions Prioritization Study. Originally published in JMIR Diabetes (https://diabetes.jmir.org), 27.04.2023.