Improvement of Care & Outcome


Silvia de Vries, Theo Sas, Jessica Bak, Dick Mul, Max Nieuwdorp, Michel Wouters, Carianne Verheugt

Socio-economic disparities in hospital care among Dutch patients with diabetes mellitus. Diabetes Obes Metab. 2024 Jan 16. Online ahead of print.

Type 1 and 2 diabetes constitute a major modern healthcare challenge, affecting around 529 million people worldwide, costing $966 billion in healthcare costs. Health care inequities exist between people from different geographical regions, backgrounds and communities. Socio-economic status (SES) is a multidimensional construct, including social and economic determinants of health. Onset, disease course and treatment outcomes of people with diabetes are negatively associated with low SES. Indeed, in the Netherlands the number of people with diabetes with low SES is higher than those with high SES. This study, co-authored by Theo Sas and Dick Mul of Diabeter, aimed to to assess the association between SES and hospital resource use in people of all ages treated for diabetes in hospitals across the Netherlands using real-world reimbursement data.


This was a population-based, retrospective cohort study using administrative hospital data from 2019 to 2020 of 196,695 people with diabetes mellitus treated in 65 hospitals across the Netherlands. People were grouped according to low, middle, or high SES based on residential areas derived from four-digit zip codes.

Key findings:

  • SES was low, middle or high in 38%, 34% and 28%, respectively
  • 5,454 children and 191,241 adults received diabetes-related hospital care between 2019 and 2020
  • Children and adults with low SES were hospitalized more often than patients with middle or high SES (children: 22%, 19% and 15%, respectively; adults: 28%, 25% and 23%)
  • People with low SES used the least technology (no technology in 48%, 40% and 38% in children with low, middle and high SES, respectively)
  • In children, insulin pump and rt-CGM use was higher in high SES compared with low SES (Odds ratios 1.75 and 1.72, respectively)
  • Macrovascular and microvascular complications were less prevalent in high compared with low SES (Odds ratios 0.78 and 0.95, respectively)


Concluding, the authors state

"Significant health inequities are present in diabetes care for patients treated in Dutch hospitals, regardless of a health care system with universal medical care coverage. Patients with low SES have an unfavourable diabetes care profile, encompassing more hospitalizations and less technology use. In addition, they more often have macrovascular and microvascular complications. These disparities warrant specific attention, specifically in children, to guarantee equality in diabetes-related outcomes later in life. " -

Please click here for the PubMed link.

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