Minority youth at greatest risk for poor glycemia trajectories in T1D
Black and Hispanic children with type 1 diabetes (T1D) are at a higher risk of increasing blood glucose levels than white children, researchers reported in JAMA Network Open.
Anna R. Kahkoska, BS, and colleagues studied 1,313 American youth below the age of 20 who had at least three hemoglobin A1c (HbA1c) measurements during an average follow-up of nine years. They stratified the individuals into three glycemia trajectories: 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).
Compared to whites, black and Hispanic participants were 7.98 and 3.29 times more likely, respectively, to be in group 3 than group 1. Even after adjustment for clinical variables and socioeconomic status, blacks were 4.54 times more likely to be included in the group with the worst HbA1c trajectory. Hispanic individuals were more than twice as likely to be in group 3 than group 1 after adjustment for those factors.
However, the associations were only statistically significant for male participants and nonwhite patients diagnosed at age 9 or younger.
“Evidence of disparity in glycemic control trajectory that exists particularly among nonwhite male patients and nonwhite youth with diabetes diagnosis at an early age (≤9 years) is consistent with previously reported patterns in acute glycemic complications that are more common among the youngest patients and male patients of all ages,” wrote Kahkoska, with the department of nutrition at University of North Carolina, et al.
“The magnitude of racial/ethnic inequity over the longitudinal data are striking,” the authors continued. “Group 3 diverged over the follow-up period to give vastly different mean HbA1c measures at the cohort visit that may translate to significant increases in the risk for complications of diabetes.”
Specifically, the odds of group 3 membership for nonwhite male participants was more than five-fold compared to a group 1 trajectory. A similar odds ratio was reported for people diagnosed at age 9 or younger, while female nonwhite participants and those diagnosed at age 9 or older had statistically similar chances of being in any of the groups.
“The social determinants of health operating outside of the healthcare system, including aspects of the physical environment, food security, social integration, barriers to healthcare, 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,” the researchers wrote. “In general, adverse childhood experiences among nonwhite youth have been shown to result in a myriad of psychological and medical sequelae later in life.”
In addition to these factors, Kahkoska and coauthors suggested implicit bias within the healthcare system may also contribute to the disparities.
“The unconscious attitudes that unintentionally influence behavior may affect health care professionals’ medical management decisions and perceptions about black, Hispanic, and young people of color in terms of disease experience and patient compliance,” they wrote. “Higher levels of perceived bias or discrimination have been linked to worse diabetes care.”
The researchers noted the sample sizes were small for the subanalyses based on sex and age at diagnosis. Larger studies are necessary to further evaluate which racial subgroups are at the highest risk for poor glycemic control, they said.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.