Low Educational Attainment Is Associated with Increased Risk of Complications in Type 2 Diabetes — a Multivariable Analysis
Clinical Diabetology, vol.15, no.4, pp.159-167, 2026 (ESCI, Scopus)
- Publication Type: Article / Article
- Volume: 15 Issue: 4
- Publication Date: 2026
- Doi Number: 10.5603/cd.111711
- Journal Name: Clinical Diabetology
- Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus
- Page Numbers: pp.159-167
- Keywords: coronary artery disease, diabetic complications, educational level, microvascular complications, type 2 diabetes
- Istanbul University Affiliated: Yes
Abstract
Objective. To evaluate the association between educational attainment and diabetes-related complications in adults with type 2 diabetes (T2D) and its potential relevance in clinical assessment. Material and methods. This cross-sectional retrospective study included 503 adults with T2D. Educational attainment was categorized as less than high school, high school, or university/postgraduate. Demographic and clinical data were retrieved from medical records. Complications were defined using predefined clinical and laboratory criteria based on medical records and specialist-confirmed diagnoses. Multivariable logistic regression analyses were performed to determine independent associations between educational attainment and predefined microvascular (retinopathy, neuropathy, nephropathy) and macrovascular (coronary artery disease) complications. Results. A total of 503 patients were included (mean age: 57.6 ± 10.2 years; 54.7% male; 61.6% with less than a high school education). Retinopathy, neuropathy, nephropathy, hypertension, coronary artery disease, and diabetic foot were significantly more prevalent in patients with less than a high school education (all p < 0.01). No significant differences were found for dyslipidemia, stroke, or peripheral arterial disease. Longer diabetes duration independently increased the odds of microvascular complications. Higher educational attainment was independently associated with lower risks of retinopathy (adjusted OR = 0.18; 95% CI: 0.05–0.58), neuropathy (adjusted OR = 0.12; 95% CI: 0.05–0.25), and coronary artery disease (adjusted OR = 0.34; 95% CI: 0.18–0.64). Conclusions. Lower educational attainment is independently associated with a higher burden of diabetes-related complications. Educational level is a readily available variable that may help contextualize patient risk within a broader clinical assessment, rather than serving as a stand-alone predictive tool.