Educational inequalities in clinical presentation and pharmacological treatment of early type 2 diabetes: A Danish prevalence study

Marie T Sørensen; Frederik P B Kristensen; Jens S Nielsen; Diana H Christensen; Sia K Nicolaisen; Henning Beck-Nielsen; Peter Vestergaard; Niels Jessen; Michael H Olsen; Torben Hansen; Allan Vaag; Henrik T Sørensen; Reimar W Thomsen

doi:10.1016/j.diabres.2025.112231

Educational inequalities in clinical presentation and pharmacological treatment of early type 2 diabetes: A Danish prevalence study

Marie T Sørensen
, Frederik P B Kristensen
, Jens S Nielsen
, Diana H Christensen^*
, Sia K Nicolaisen
, Henning Beck-Nielsen
, Peter Vestergaard
, Niels Jessen
, Michael H Olsen
, Torben Hansen
, Allan Vaag
, Henrik T Sørensen
, Reimar W Thomsen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

AIMS: To examine how educational attainment impacts clinical presentation and pharmacological treatment at type 2 diabetes (T2D) diagnosis.

METHODS: Cross-sectional analysis of 10,020 individuals with recently diagnosed T2D enrolled in the Danish prospective DD2 cohort. Sex- and age-adjusted prevalence ratios (aPRs) for detailed clinical characteristics and pharmacotherapy were computed.

RESULTS: In total, 31 % had low, 50 % had moderate, and 19 % had high educational level. Individuals with low rather than high educational level were more often obese (58 % vs 49 %, aPR 1.20 [95 % CI 1.14-1.28]); had less healthy lifestyles (current smokers: 22 % vs 15 %, aPR 1.53 [1.32-1.76]); sedentary activity level: 21 % vs 15 %, aPR 1.36 [1.20-1.55]); and had more often cardiovascular (23 % vs. 17 %, PR 1.30 [1.16-1.46]) and microvascular complications (16 % vs 13 %, aPR 1.18 [1.02-1.35]). Low education associated with higher triglycerides, more insulin resistance, and poorer kidney function, whereas HbA1c, blood pressure, and LDL cholesterol were identical. The use of medications with cardiovascular benefits and newer organ-protective diabetes medications was similar to, or higher than, that in individuals with high education.

CONCLUSIONS: Awareness of the impact of social and educational determinants on T2D presentation at diagnosis is essential to improve treatment and prognosis.

Original language	English
Article number	112231
Number of pages	9
Journal	Diabetes Research and Clinical Practice
Volume	225
Early online date	15 May 2025
DOIs	https://doi.org/10.1016/j.diabres.2025.112231
Publication status	Published - Jul 2025

Funding

M.T.S.'s work was supported by a research year grant from Aarhus University. D.H.C. is supported by a research grant from the Danish Diabetes and Endocrine Academy, which is funded by the Novo Nordisk Foundation (grant number NNF22SA0079901). PV is head of research at SDCN funded by the Novo Nordisk Foundation. The Danish Centre for Strategic Research in Type 2 Diabetes Project is supported by the Danish Agency for Science (grant numbers 09-067009, 10-079102, and 09-075724), the Danish Health Authority, the Danish Medicines Agency, the Danish Diabetes Association, and the Novo Nordisk Foundation (grant numbers NNF17SA0030364, NNF16SA0024768, and NNF20OC0063292). Project partners are listed on the website www. DD2.dk. AV is coordinator of the Swedish strategic research alliance EXODIAB funded by the Swedish Research Council (EXODIAB, 2009-1039; 2018-02837).

Funders	Funder number
Aarhus University
Novo Nordisk Foundation	NNF22SA0079901
Novo Nordisk Foundation	NNF17SA0030364, NNF16SA0024768, NNF20OC0063292
Danish Agency for Science, Technology and Innovation	09-067009, 10-079102, 09-075724
Danish Health Authority
Danish Medicines Agency
Danish Diabetes Association
Swedish Research Council	2009-1039, 2018-02837

Keywords

Clinical characteristics
Educational level
Pharmacological treatment
Socioeconomic disparities
Type 2 diabetes
Prevalence
Prospective Studies
Cross-Sectional Studies
Humans
Middle Aged
Male
Educational Status
Denmark/epidemiology
Diabetes Mellitus, Type 2/drug therapy
Female
Adult
Hypoglycemic Agents/therapeutic use
Aged

Access to Document

10.1016/j.diabres.2025.112231

Cite this

Sørensen, M. T., Kristensen, F. P. B., Nielsen, J. S., Christensen, D. H., Nicolaisen, S. K., Beck-Nielsen, H., Vestergaard, P., Jessen, N., Olsen, M. H., Hansen, T., Vaag, A., Sørensen, H. T., & Thomsen, R. W. (2025). Educational inequalities in clinical presentation and pharmacological treatment of early type 2 diabetes: A Danish prevalence study. Diabetes Research and Clinical Practice, 225, Article 112231. https://doi.org/10.1016/j.diabres.2025.112231

@article{65e019b709514436996182e8d1529d04,

title = "Educational inequalities in clinical presentation and pharmacological treatment of early type 2 diabetes: A Danish prevalence study",

abstract = "AIMS: To examine how educational attainment impacts clinical presentation and pharmacological treatment at type 2 diabetes (T2D) diagnosis.METHODS: Cross-sectional analysis of 10,020 individuals with recently diagnosed T2D enrolled in the Danish prospective DD2 cohort. Sex- and age-adjusted prevalence ratios (aPRs) for detailed clinical characteristics and pharmacotherapy were computed.RESULTS: In total, 31 \% had low, 50 \% had moderate, and 19 \% had high educational level. Individuals with low rather than high educational level were more often obese (58 \% vs 49 \%, aPR 1.20 [95 \% CI 1.14-1.28]); had less healthy lifestyles (current smokers: 22 \% vs 15 \%, aPR 1.53 [1.32-1.76]); sedentary activity level: 21 \% vs 15 \%, aPR 1.36 [1.20-1.55]); and had more often cardiovascular (23 \% vs. 17 \%, PR 1.30 [1.16-1.46]) and microvascular complications (16 \% vs 13 \%, aPR 1.18 [1.02-1.35]). Low education associated with higher triglycerides, more insulin resistance, and poorer kidney function, whereas HbA1c, blood pressure, and LDL cholesterol were identical. The use of medications with cardiovascular benefits and newer organ-protective diabetes medications was similar to, or higher than, that in individuals with high education.CONCLUSIONS: Awareness of the impact of social and educational determinants on T2D presentation at diagnosis is essential to improve treatment and prognosis.",

keywords = "Clinical characteristics, Educational level, Pharmacological treatment, Socioeconomic disparities, Type 2 diabetes, Prevalence, Prospective Studies, Cross-Sectional Studies, Humans, Middle Aged, Male, Educational Status, Denmark/epidemiology, Diabetes Mellitus, Type 2/drug therapy, Female, Adult, Hypoglycemic Agents/therapeutic use, Aged",

author = "S{\o}rensen, \{Marie T\} and Kristensen, \{Frederik P B\} and Nielsen, \{Jens S\} and Christensen, \{Diana H\} and Nicolaisen, \{Sia K\} and Henning Beck-Nielsen and Peter Vestergaard and Niels Jessen and Olsen, \{Michael H\} and Torben Hansen and Allan Vaag and S{\o}rensen, \{Henrik T\} and Thomsen, \{Reimar W\}",

year = "2025",

month = jul,

doi = "10.1016/j.diabres.2025.112231",

language = "English",

volume = "225",

journal = "Diabetes Research and Clinical Practice",

issn = "0168-8227",

publisher = "Elsevier Ireland Ltd",

}

Sørensen, MT, Kristensen, FPB, Nielsen, JS, Christensen, DH, Nicolaisen, SK, Beck-Nielsen, H, Vestergaard, P, Jessen, N, Olsen, MH, Hansen, T, Vaag, A, Sørensen, HT & Thomsen, RW 2025, 'Educational inequalities in clinical presentation and pharmacological treatment of early type 2 diabetes: A Danish prevalence study', Diabetes Research and Clinical Practice, vol. 225, 112231. https://doi.org/10.1016/j.diabres.2025.112231

TY - JOUR

T1 - Educational inequalities in clinical presentation and pharmacological treatment of early type 2 diabetes

T2 - A Danish prevalence study

AU - Sørensen, Marie T

AU - Kristensen, Frederik P B

AU - Nielsen, Jens S

AU - Christensen, Diana H

AU - Nicolaisen, Sia K

AU - Beck-Nielsen, Henning

AU - Vestergaard, Peter

AU - Jessen, Niels

AU - Olsen, Michael H

AU - Hansen, Torben

AU - Vaag, Allan

AU - Sørensen, Henrik T

AU - Thomsen, Reimar W

PY - 2025/7

Y1 - 2025/7

N2 - AIMS: To examine how educational attainment impacts clinical presentation and pharmacological treatment at type 2 diabetes (T2D) diagnosis.METHODS: Cross-sectional analysis of 10,020 individuals with recently diagnosed T2D enrolled in the Danish prospective DD2 cohort. Sex- and age-adjusted prevalence ratios (aPRs) for detailed clinical characteristics and pharmacotherapy were computed.RESULTS: In total, 31 % had low, 50 % had moderate, and 19 % had high educational level. Individuals with low rather than high educational level were more often obese (58 % vs 49 %, aPR 1.20 [95 % CI 1.14-1.28]); had less healthy lifestyles (current smokers: 22 % vs 15 %, aPR 1.53 [1.32-1.76]); sedentary activity level: 21 % vs 15 %, aPR 1.36 [1.20-1.55]); and had more often cardiovascular (23 % vs. 17 %, PR 1.30 [1.16-1.46]) and microvascular complications (16 % vs 13 %, aPR 1.18 [1.02-1.35]). Low education associated with higher triglycerides, more insulin resistance, and poorer kidney function, whereas HbA1c, blood pressure, and LDL cholesterol were identical. The use of medications with cardiovascular benefits and newer organ-protective diabetes medications was similar to, or higher than, that in individuals with high education.CONCLUSIONS: Awareness of the impact of social and educational determinants on T2D presentation at diagnosis is essential to improve treatment and prognosis.

AB - AIMS: To examine how educational attainment impacts clinical presentation and pharmacological treatment at type 2 diabetes (T2D) diagnosis.METHODS: Cross-sectional analysis of 10,020 individuals with recently diagnosed T2D enrolled in the Danish prospective DD2 cohort. Sex- and age-adjusted prevalence ratios (aPRs) for detailed clinical characteristics and pharmacotherapy were computed.RESULTS: In total, 31 % had low, 50 % had moderate, and 19 % had high educational level. Individuals with low rather than high educational level were more often obese (58 % vs 49 %, aPR 1.20 [95 % CI 1.14-1.28]); had less healthy lifestyles (current smokers: 22 % vs 15 %, aPR 1.53 [1.32-1.76]); sedentary activity level: 21 % vs 15 %, aPR 1.36 [1.20-1.55]); and had more often cardiovascular (23 % vs. 17 %, PR 1.30 [1.16-1.46]) and microvascular complications (16 % vs 13 %, aPR 1.18 [1.02-1.35]). Low education associated with higher triglycerides, more insulin resistance, and poorer kidney function, whereas HbA1c, blood pressure, and LDL cholesterol were identical. The use of medications with cardiovascular benefits and newer organ-protective diabetes medications was similar to, or higher than, that in individuals with high education.CONCLUSIONS: Awareness of the impact of social and educational determinants on T2D presentation at diagnosis is essential to improve treatment and prognosis.

KW - Clinical characteristics

KW - Educational level

KW - Pharmacological treatment

KW - Socioeconomic disparities

KW - Type 2 diabetes

KW - Prevalence

KW - Prospective Studies

KW - Cross-Sectional Studies

KW - Humans

KW - Middle Aged

KW - Male

KW - Educational Status

KW - Denmark/epidemiology

KW - Diabetes Mellitus, Type 2/drug therapy

KW - Female

KW - Adult

KW - Hypoglycemic Agents/therapeutic use

KW - Aged

U2 - 10.1016/j.diabres.2025.112231

DO - 10.1016/j.diabres.2025.112231

M3 - Article

C2 - 40381656

SN - 0168-8227

VL - 225

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

M1 - 112231

ER -

Educational inequalities in clinical presentation and pharmacological treatment of early type 2 diabetes: A Danish prevalence study

Abstract

Funding

Keywords

Access to Document

Fingerprint

Cite this