- Minority youth with type 1 diabetes were at higher risk of increasing blood glucose levels compared with whites.
- Note that these increased risks of a worse HbA1c trajectory for minority youth only applied to males and no significant difference in risk was seen for females.
Minority youth with type 1 diabetes were at higher risk of increasing blood glucose levels compared with whites, researchers found.
In a longitudinal cohort study of people younger than 20 diagnosed with type 1 diabetes, black participants had eight-fold higher odds of showing moderate baseline HbA1c levels with major increases over time, compared with non-Hispanic white youth in an unadjusted model (OR 7.98, 95% CI 4.42-14.38), reported Anna Kahkoska, BS, of the University of North Carolina at Chapel Hill, and colleagues.
Similarly, Hispanic youth had more than three-fold higher odds for this worse HbA1c trajectory compared with non-Hispanic whites (OR 3.29, 95% CI 1.78-6.08), the researchers wrote in JAMA Network Open.
Even after adjustment for sociodemographic and clinical factors including age of diagnosis, health insurance, BMI, insulin regimen, insulin dose and frequency of blood glucose monitoring, black and Hispanic youth still had significantly higher odds of a worse HbA1c trajectory (aOR 4.54, 95% CI 2.08-9.89, for blacks; aOR 2.24, 95% CI 1.02-4.92, for Hispanics).
Importantly, however, these increased risks for minority youth only applied to males (OR 5.34, 95% CI 2.16-13.2, for minority versus white males). No significant difference in risk was seen for females.
"The social determinants of health operating outside of the health care system, including aspects of the physical environment, food security, social integration, barriers to health care, and complex patterns in health care utilization, may create race-based groups of individuals for whom glycemic control is challenged by inconsistencies in the availability of resources or support for T1D management," Kahkoska and colleagues suggested, while noting factors within the healthcare system underlying these relationships.
For example, these modifiable factors may potentially include "racial/ethnic differences in the interpersonal dynamics of interactions between patients or parents and healthcare professionals that occur in pediatric clinical settings, extending from implicit bias and microaggressions to stereotyping, prejudice, and macroaggressions."
For this analysis, the researchers analyzed a sample of 1,313 newly diagnosed individuals from the SEARCH for Diabetes in Youth study. Based upon a minimum of three HbA1c measurements over 6-13 years of follow-up, the researchers stratified youth into three trajectory categories: low baseline HbA1c with mild increases (group 1), moderate baseline HbA1c with moderate increases (group 2), and moderate baseline HbA1c with major increases (group 3).
Although only 7.5% of the total study participants fell into group 3 for disease trajectory, the prevalence of black and Hispanic youth was highest in this group and was also lowest in group 1:
- Group 1: 5.1% black; 8.4% Hispanic; 84.7% white
- Group 2: 12.6% black; 12.2% Hispanic; 72.1% white
- Group 3: 25.3% black; 17.2% Hispanic; 52.5% white
When interpreting these findings, it's important to keep in mind that there is "now clear evidence that on average black patients have a higher HbA1c level than white patients for the same mean glucose concentration... [at a] magnitude of 0.4%," wrote Kellee Miller, PhD, of the Jaeb Center for Health Research in Tampa, Florida, in an accompanying editorial. However, she also noted that this difference would be unlikely to influence trajectories of HbA1c levels, and that the magnitude of difference between the participants reported in this study was greater than 0.4%.
Miller also agreed with Kahkoska's group that disparities in social determinants of health and possible healthcare bias were likely at play here.
"These factors are not easily assessed but it is critical that further research is undergone to understand the observed racial disparities to design targeted interventions," she added, suggesting that the "more pronounced racial differences in HbA1c patterns in male youth are an interesting finding that warrants further investigation."0 comments