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Insulin pump use, optimal glycemic control less likely in black children
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Even after controlling for socioeconomic status and education, black children with type 1 diabetes are less likely than white or Hispanic children to use an insulin pump or maintain optimal glycemic control, according to study findings published in Pediatrics.
“Sadly, these results are not completely surprising, as previous studies done in much smaller populations have had somewhat similar findings,” Steven M. Willi, MD, director of the diabetes center for children at the Children’s Hospital of Philadelphia, told Endocrine Today. “Nonetheless, these results are disappointing, as they uncover some of the inequities which still exist in our health care system. What is most remarkable about our findings is the fact that they are so consistent in a very large data set, suggesting that these influences on medical care and diabetes outcomes are ubiquitous.”
Steven M. Willi
Willi and colleagues evaluated data from 10,704 participants of the T1D Diabetes Exchange Clinic Registry to determine diabetes management and clinical outcome disparities among children of different ethnic groups.
Participants were younger than 18 years, had type 1 diabetes for at least 1 year, were 83% white, 11% Hispanic and 7% black. Overall, 214 high-income black and Hispanic families were included among the participants.
More than three-quarters of white participants lived in families whose income was at least $50,000 compared with 36% of black families and 46% of Hispanic families (P < .001).
Insulin pump therapy was used by 57% of all participants, and 43% took insulin injections.
After controlling for gender, age, diabetes duration and socioeconomic status, white participants had higher rates of pump use compared with black or Hispanic participants (P < .001). White participants were 3.6 times more likely to use a pump than a black participant and 1.9 times more likely than a Hispanic participant. White participants also were twice as likely as black participants to use a pump, even when both groups did not have private insurance (P < .001).
Older children were more likely to be prescribed an insulin pump soon after diagnosis compared with younger children for all groups.
Compared with black and Hispanic participants, white participants had a greater mean number of self-monitoring blood glucose measurements per day (P < .001). Black participants had higher mean HbA1c levels compared with white or Hispanic participants (adjusted P <.001). Compared with white and Hispanic participants, black participants experienced diabetic ketoacidosis and severe hypoglycemic in the past year more often as well (both P < .001).
“The results of our study highlight the importance of health care providers continuing to strive for cultural sensitivity in their practices,” Willi told Endocrine Today. “If the disparities in diabetes care and outcomes we observed are due, in part, to subliminal racial bias, it will be helpful to recognize that this bias exists, and actively work toward its eradication. We hope this publication, in some way, contributes to the careful consideration of racial/ethnic bias by its readers.”
In an accompanying editorial, Stuart A. Chalew, MD, of the Children’s Hospital of New Orleans, wrote that additional work is needed to help develop and implement safe and effective solutions for better long-term health outcomes.
“The T1D Exchanges Clinic Network report challenges us to identify and confront the sources of ongoing disparities in our young patients with [type1 diabetes],” Chalew wrote.
He added that in addition to psycho-socioeconomic differences between ethnic groups, prior research has suggested that there may be true biologic differences between blacks and whites leading to higher HbA1c in blacks, despite similar mean blood glucose. This difference could explain a higher occurrence of hypoglycemic in blacks despite higher HbA1c.
“If this is so, then many clinicians, in an effort to bring HbA1c levels of black patients lower, may unwittingly prescribe higher doses of insulin leading to a greater occurrence of hyporclycemia, just as was reported in the T1D Exchange group report,” Chalew told Endocrine Today. “Therefore, clinicians should be cautious in treatment of black type 1 diabetes patients and closely monitor blood glucose data in their black patients along with HbA1c to prevent unnecessary increases in hypoglycemia.” – by Amber Cox
Disclosure: Chalew and Miller report no relevant financial disclosures. See the full study for all other authors’ relevant financial disclosures.
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