1279-P: Socioeconomic Factors Associated with Poor Glycemic Control in People with Type 2 Diabetes: The DISCOVER Study
Authors: GOMES MARILIA B. , TANG FENGMING , CHEN HUNGTA , CID-RUZAFA JAVIER , FENICI PETER , KHUNTI KAMLESH , POCOCK STUART , RATHMANN WOLFGANG , SHESTAKOVA MARINA V. , SURMONT FILIP , WATADA HIROTAKA , MEDINA JESUS , SADIKOT SHAUKAT M. , SHIMOMURA IICHIRO , SARAIVA GABRIELA LUPORINI , NICOLUCCI ANTONIO 
Published: June 2019

Background: DISCOVER is a 3-year, observational study of patients with type 2 diabetes (T2D) initiating second-line glucose-lowering therapy in 38 countries. We assessed socioeconomic factors associated with poor glycemic control (HbA1c ≥ 9.0%) at baseline.
Methods: In total, 15 342 participants from 36 countries were evaluated. HbA1c levels were recorded in 12 261 participants (79.9%). Factors associated with an increased likelihood of having HbA1c ≥ 9.0% were assessed using a hierarchical logistic regression model.
Results: The mean HbA1c level was 8.4% (SD: 1.7%); 48.9%, 23.4% and 27.7% of patients had HbA1c &lt; 8.0%, ≥ 8.0 to &lt; 9.0%, and ≥ 9.0%, respectively. Socioeconomic factors associated with an increased likelihood of having HbA1c ≥ 9.0% (Figure) included living in lower middle-income (vs. high-income) countries, being treated at a site with public/governmental or mixed (vs. private) funding, having public or no (vs. private) health insurance and having primary or no formal (vs. secondary or higher) education. Male sex and being younger than 50 years of age were also associated with an increased likelihood of having HbA1c ≥ 9.0%.
Conclusions: Lower socioeconomic status is associated with an increased likelihood of having HbA1c ≥ 9.0% in people with T2D initiating second-line therapy. Efforts are needed to address social determinants of health in patients with T2D.

Disclosure
M.B. Gomes: Advisory Panel; Self; AstraZeneca. Consultant; Self; Merck KGaA. Research Support; Self; CNPq, FAPERJ. F. Tang: Employee; Self; Mid America Heart Institute. Research Support; Self; AstraZeneca. H. Chen: Employee; Self; AstraZeneca. J. Cid-Ruzafa: Employee; Self; Evidera. P. Fenici: Employee; Self; AstraZeneca. K. Khunti: Advisory Panel; Self; Amgen Inc., AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier, Takeda Pharmaceutical Company Limited. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis. Speaker's Bureau; Self; AstraZeneca, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Menarini Group, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi, Servier, Takeda Pharmaceutical Company Limited. S. Pocock: Consultant; Self; AstraZeneca. W. Rathmann: Advisory Panel; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim International GmbH. Research Support; Self; Novo Nordisk A/S. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk A/S. M.V. Shestakova: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier. Research Support; Self; Novo Nordisk A/S, Sanofi. F. Surmont: Employee; Self; AstraZeneca. H. Watada: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kissei Pharmaceutical Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Pfizer Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Sanofi, Takeda Pharmaceutical Company Limited, Terumo Medical Corporation. Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Kowa Pharmaceutical Europe Co. Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Sanwa Chemical Industry Co. Ltd., Takeda Pharmaceutical Company Limited. J. Medina: Employee; Self; AstraZeneca. S.M. Sadikot: Consultant; Self; AstraZeneca. I. Shimomura: Advisory Panel; Self; AstraZeneca, Novo Nordisk Pharma Ltd., Sanwa Kagaku Kenkyusho. Consultant; Self; MSD K.K., Novo Nordisk Pharma Ltd., Taisho Pharmaceutical Co., Ltd. Research Support; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kaken Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Shionogi & Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K., Kowa Pharmaceutical Co., Ltd., Lotte Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K.K., Sanwa Kagaku Kenkyusho, Taisho Toyama Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited. G. Luporini Saraiva: Employee; Self; AstraZeneca. A. Nicolucci: Consultant; Self; AstraZeneca, Eli Lilly and Company, Medtronic, Novo Nordisk A/S. Research Support; Self; Artsana S.p.A., Dexcom, Inc., Novo Nordisk A/S, Sanofi-Aventis.

Funding
AstraZeneca