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Poor glycemic control more likely in minority youths than white youths
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SAN DIEGO — The risk for major increases in HbA1c is higher among minority youth with type 1 diabetes compared with white youth with type 1 diabetes, according to a presenter here.
“This work is broadly motivated by racial and ethnic disparities that exist in context of type 1 diabetes,” Anna R. Kahkoska, a PhD candidate in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, said during a presentation. “Over the years, the SEARCH study has shown that differences across race and ethnicity exist in clinical levels, including in the incidence and prevalence of disease, clinical outcomes and in the rate of complications.”
Kahkoska and colleagues evaluated data from the SEARCH for Diabetes in Youth study on 1,313 children (mean age, 9.7 years) with type 1 diabetes (diagnosed between 2002 and 2005; mean diabetes duration at baseline, 9.2 months) to determine disease disparities in glycemic control over time. Participants were 77.2% white, 10.7% Hispanic, 9.7% black and 2.5% other.
Three HbA1c trajectories ranging from minor to major deterioration in HbA1c during 109 months of diabetes duration were identified through group-based trajectory modeling. The groups included participants with low baseline and mild HbA1c increases (46.3%; group 1), moderate baseline and moderate HbA1c increases (45.5%; group 2) and high baseline and major HbA1c increases (8.2%; group 3).
More minority participants were in group 3 (46.1%) compared with group 1 (15.4%) and group 2 (17%; P < .001). The association between higher HbA1c trajectories and minority participants persisted after adjustment for baseline demographics, socioeconomic status and clinical factors (P < .001). When considering the presence of depressive symptoms, female sex and age at diagnosis (< 9 years), the association remained between higher HbA1c trajectories and minority participants.
“One of the biggest takeaways from this analysis was the observation that we were unable to fully explain health inequity with adjustments for demographics and socioeconomic status,” Kahkoska said. “We think that there may be other aspects of health disparities that explain this inequity, including microaggression in the clinic. In the future, it may be useful to plug data to look into these aspects.” – by Amber Cox
Reference:
Kahkoska AR, et al. 79-OR. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.
Disclosures: The researchers report no relevant financial disclosures.