Low Socioeconomic Status and Increased Risk of Severe Hypoglycemia in Type 1 Diabetes: A Systematic Literature Review

OBJECTIVEWe systematically reviewed the literature to determine whether low socioeconomic status is associated with severe hypoglycemia in individuals with type 1 diabetes in developed countries.METHODSWe searched 7 electronic databases and retrieved 620 citations and 30 full-text papers, which were all independently reviewed by 2 investigators. Consensus was reached between reviewers on inclusion of studies. Data were abstracted by 1 investigator and verified by another investigator.RESULTSNine observational studies were included in the review (6 pediatric, 3 adult). Five of the studies were from Europe, 3 from the United States and 1 from Australia. A statistically significant independent association of low socioeconomic status with severe hypoglycemia (after adjustment for other variables) was reported in 4 studies.CONCLUSIONSLow socioeconomic status may be associated with an increased incidence of severe hypoglycemia in type 1 diabetes; however, this relationship has been inconsistently observed in the existing literature.