Glycaemic control and complications in people with diabetes:  sex and socioeconomic status differences in the city of Madrid

Background: Differences in complications and multimorbidity for people with type 2 diabetes mellitus (T2D) have been found according to patient sex and socioeconomic status (SES). We analysed the association between sex and SES with glycaemic and cardiovascular control in diabetic primary care patients from the whole city of Madrid. Methods: : This was an observational, descriptive, retrospective, multicenter study with an analytical approach within the Heart Healthy Hood Project (HHH). A total of 68,535 T2D patients between 40-75 years who were living in the municipality of Madrid were included. Age, sex, area-level SES (in quintiles from least to most wealth), tobacco use, comorbidities, complications, and health center characteristics were collected from primary care electronic health records during 2017-2018. The primary outcome was glycaemic control indicated by an HbA1c ≤ 7%. The secondary outcomes were combined control target (HbA1c ≤ 7%, blood pressure (BP), < 140/90 mm Hg, LDL <100 mg/ml) and body mass index (BMI) <30 kg/m2). Descriptive, bivariate analyses and multilevel logistic regression models analyzed factors associated with suboptimal glycaemic control. Results: The mean age was 62.7 years old, 43,2% were female. Glycaemic control was achieved by 63% of patients. Women had better glycaemic control than men (64.2% vs 62.4%). Those who were in quintile 1 of SES achieved glycaemic control more often than those in quintile 5 (65.9% vs 59.7%). The optimal combined target (HbA1c, BP, LDL) was reached by 10% of patients (women: 9.3% vs men: 11.2%), especially those in quintile 5. If BMI<30 kg/m 2 was added, the combined target attainment rate decreased to 6.6%. In the adjusted regression model, we found that sex (AOR:0.97, 95%CI: 0.94-1.01) was not related with suboptimal glycaemic control but being part of quintile 4 (AOR: 1.02, 95% CI: 1.06-1.26) and 5 (AOR: 1.20, 95% CI: 1.10-1.32) of SES was associated with not reaching the glycaemic goal. Conclusions: : Suboptimal glycaemic and combined control were associated with being less affluent but not with sex in the whole population of people with diabetes in the city of Madrid. Public policies and doctors should take social determinants into account to reduce social and health inequalities.