Young Minorities With Type 1 Diabetes Have Worse Outcome Indicators

Liam Davenport

March 07, 2018

Young patients with type 1 diabetes from ethnic minorities are more like than their white peers to have markers of a poor prognosis, which in turn may explain their worse longer-term outcomes, say US researchers.

The study of over 900 young patients with type 1 diabetes, published online March 1 in Diabetes Care, shows that African Americans were more likely to have hypertension and severe hypoglycemic events than non-Hispanic whites.

They also had worse trajectories for HbA1c levels, insulin doses, percentile body mass index (BMI), and other key outcome indicators, and were less likely to have partial remission, known as the 'honeymoon period'.

Furthermore, Robin L Gal, MSPH, Jaeb Center for Health Research, Tampa, Florida, and colleagues also found that Hispanics with type 1 diabetes had a higher BMI at diagnosis, higher prevalence of dyslipidemia, and worse insulin-dose trajectory than whites.

The results show that young African American and Hispanic patients "have worse early outcomes and prognostic factors for complications than non-Hispanic whites during the first critical years after diagnosis of type 1 diabetes," the team writes.

"The poorer early trajectory may contribute to the increased risk of long-term complications of diabetes in minority youth in the United States," they continue.

"Clinicians should be alerted to their higher risk of specific comorbidities so that appropriate screening and management are implemented."

Participants Followed for 3 Years After Diabetes Diagnosis

It is well-established that there are health disparities in the United States among patients with type 1 diabetes based on ethnicity, with those from minorities having worse long-term outcomes than whites.

However, there has been little study of ethnic differences in type 1 diabetes in terms of baseline characteristics, early outcomes, treatments, and presence of cardiovascular risk factors, say the researchers.

To investigate further, the team examined data on 927 participants with type 1 diabetes younger than age 19 years from the Pediatric Diabetes Consortium, which included 631 whites, 216 Hispanics, and 80 African Americans.

Demographic, socioeconomic, and clinical data were collated from medical records and participant/parent interviews. Participants received usual care and were followed for a median of 3.0 years after diabetes diagnosis.

The mean age at diagnosis was similar in the three ethnic groups at between 9.1 and 9.8 years.

However, African American youth had a significantly higher percentile BMI at diagnosis than whites, at a median of 70% vs 43% (P = .01) and were at a more advanced Tanner stage of pubertal development (P < .001 for trend).

African American youths were also more likely than whites to present with diabetic ketoacidosis, at 48% vs 32% (P = .004), although this ceased to be significant after taking into account health insurance coverage (P = .08).

During follow-up, African Americans were more likely than whites to have hypertension (15% vs 7%; P = .009), severe hypoglycemic events (11% vs 4%; P = .004), and diabetic ketoacidosis episodes (53% vs 36%; P = .004).

Again, the difference in diabetic ketoacidosis episodes was no longer significant after taking into account health insurance coverage (P = .09), and severe hypoglycemic events were of only borderline significance after taking into account parental education (P = .02).

However, even after adjustment for socioeconomic factors, African Americans had significantly higher trajectories than non-Hispanic whites in terms of HbA1c levels, insulin doses, percentile BMI, and insulin dose-adjusted HbA1c (IDAA1c), and were less likely to enter partial remission (P < .001 for all).

Compared with whites, Hispanics had a significantly higher adjusted percentile BMI at diagnosis, at 64% vs 43% (P = .002). They also tended to be at a more advanced stage of puberty and be positive for GAD65 and insulin autoantibodies.

And during follow-up, Hispanics were significantly more likely than whites to have a diagnosis of dyslipidemia (P < .001) and tended to have more severe hypoglycemia, although this difference disappeared after taking into account parental education (P = .36).

Hispanics had a significantly higher percentile BMI trajectory than whites, as well as a higher insulin dose and IDAA1c trajectory (P < .001 for all). Other differences were not significant after adjustment for socioeconomic factors.

Findings Highlight Need for Research on Reasons for Disparities

The researchers say that the findings "underscore the importance of integrating race/ethnicity in predictive models for outcomes of interest to guide efforts to improve population health management."

"Furthermore, this study highlights the need for research that focuses on the gaps in knowledge on the etiology of racial differences in factors that predict poor diabetes outcomes and informs intervention trials that target vulnerable populations."

The PDC and its activities are supported by the Jaeb Center for Health Research Foundation through unrestricted grants from Novo Nordisk, Boehringer Ingelheim, and Takeda. Cheng, Klingensmith, and Gal have received grant funding from Novo Nordisk, Boehringer Ingelheim, and Takeda. Klingensmith is a paid consultant for Novo Nordisk and has received grant funding from Novo Nordisk, Boehringer Ingelheim, and Takeda. Clements is a paid consultant for Medtronic and Novo Nordisk.

Diabetes Care. Published online March 1, 2018. Abstract

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