Outcome Disparities Among Ethnic Minorities With T1D

On March 1, 2018, Diabetes Care published a study that compared the prognosis among young patients with Type 1 diabetes from different ethnic groups. The study, led by Maria Jose Redondo et. al. for the Pediatric Diabetes Consortium, involved over 900 participants (631 whites, 216 Hispanics, and 80 African Americans) under the age of 19. The research team aggregated demographic, socioeconomic, and clinical data from medical records and interviews with patients and parents for three years after diagnosis.

The purpose of the study was not to prove that disparities in outcomes exist between whites and ethnic minorities, since this fact is already well-established. Rather, it was to more closely identify baseline characteristics, early outcomes, treatments, and other cardiovascular risk factors.

The mean age at diagnosis was similar in the three ethnic groups, but BMI was not. African American youth averaged 70% BMI compared to whites’ 43%. These youth also presented with a more advanced Tanner stage of pubertal development, and they were more likely to present with DKA at time of diagnosis (48% to 32%). These disparities were less significant after researchers considered socioeconomic factors, such as health insurance coverage and parental education.

However, researchers found that African Americans were also more likely to develop hypertension, experience severe hypoglycemic events, and have higher trajectories of HbA1C levels, compared to non-Hispanic whites, while being less likely to benefit from a partial remission or “honeymoon” phase. These disparities remained even after considering socioeconomic factors.

Hispanics also had a significantly higher percentile of BMI at the time of diagnosis compared to whites (64% vs 43%). They, too, presented at a more advanced stage of puberty and were more likely to be positive for GAD65 and insulin autoantibodies. There was a higher prevalence of dyslipidemia and worse insulin-dose trajectory than whites. However, in the case of Hispanics, disparities were not significant after socioeconomic considerations.

According to researchers, the study “underscore[s] the importance of integrating race/ethnicity in predictive models for outcomes of interest to guide efforts to improve population health management.” Poorer early trajectory, for instance, could increase risk of long-term complications. Clinicians should be aware of such risk factors and screen as needed. The team emphasized the urgent need for more research focused on the etiology of racial differences in factors that predict poor diabetes outcomes.

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Audrey Farley is a former editor of Insulin Nation.

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