[Impact of urban economic level on glycemic control in patients with type 1 diabetes mellitus using do-it-yourself artificial pancreas systems].

OBJECTIVES

Do-it-yourself artificial pancreas systems (DIYAPS) have gradually been applied in glycemic management for patients with type 1 diabetes mellitus (T1DM). However, differences in glycemic outcomes among individuals from different socioeconomic backgrounds remain unclear. This study aimed to investigate the impact of urban economic level on glycemic control in Chinese patients with T1DM using DIYAPS.

METHODS

This real-world study recruited patients with T1DM from online diabetes communities between September 2019 and February 2024. The study population covered 82 cities across 26 provinces in China, and all participants used AndroidAPS system. Demographic characteristics, physical examination data, laboratory parameters, and continuous glucose monitoring (CGM) data were collected. New first-tier and first-tier cities were classified as the developed-city group, whereas second-tier and third-tier cities were classified as the developing-city group. Glycemic metrics during different time periods were compared between the 2 groups. Univariate and multivariate Logistic regression models were used to analyze the association between the low blood glucose index (LBGI) and urban economic level in patients with T1DM.

RESULTS

A total of 124 patients with T1DM were enrolled, including 56 patients (45.2%) from developed cities and 68 patients (54.8%) from developing cities. Among them, 52 patients (41.9%) were male and 72 patients (58.1%) were female. The median age was 22.3 (9.3, 32.5) years, and the median disease duration was 0.8 (0, 8.8) years. No statistically significant difference was observed between the two groups in all-day time in range (TIR) [percentage of time with glucose levels 3.9-7.8 mmol/L, TIR(7.8)] (P>0.05). However, the all-day low blood glucose index (LBGI) was significantly lower in the developed-city group than in the developing-city group [1.1 (0.6, 1.5) vs 1.5 (0.9, 2.4), P<0.05], whereas time above range (TAR) [percentage of time with glucose levels >7.8 mmol/L, TAR(7.8)] was significantly higher in the developed-city group [36.3% (28.7%, 49.2%) vs 30.9% (19.2%, 40.8%), P<0.05]. Multivariate logistic regression analysis indicated that, after adjusting for age, sex, body mass index (BMI), and annual household income per capita, urban economic level remained an independent factor associated with hypoglycemia risk in patients (OR=0.43, 95% CI 0.20 to 0.91, P=0.028).

CONCLUSIONS

Urban economic level has an important impact on glycemic control in patients with T1DM using DIYAPS. Higher urban economic level is associated with a lower risk of hypoglycemia in patients with T1DM.