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Racial differences in metabolic control of children and adolescents with type I diabetes mellitus
A M Delamater1, D R Albrecht, D C Postellon
1Department of Psychology, Wayne State University, Detroit, MI 48202.
Insights
Black children with type 1 diabetes have poorer metabolic control than white children, indicated by higher HbA1 levels. This disparity is linked to factors like higher insulin needs and missed clinic visits, highlighting a critical health equity issue.
Area of Science:
- Pediatrics
- Endocrinology
- Public Health
Background:
- Type 1 diabetes mellitus (T1DM) is a chronic condition requiring lifelong management.
- Metabolic control, assessed by HbA1 levels, is crucial for preventing long-term T1DM complications.
- Racial disparities in healthcare outcomes are a significant concern in pediatric chronic diseases.
Purpose of the Study:
- To investigate racial differences in metabolic control among children and adolescents with T1DM.
- To examine how race interacts with age and sex in influencing T1DM metabolic control.
- To identify potential contributing factors to observed racial disparities in T1DM management.
Main Methods:
- A cross-sectional study comparing 102 black and 108 white children with T1DM.
- Data collection included HbA1, insulin dosage, duration of diabetes, socioeconomic status (SES), and healthcare utilization (clinic visits, hospitalizations for diabetic ketoacidosis [DKA]).
- Statistical analyses were performed to compare variables between racial groups, adjusting for relevant covariates.
Main Results:
- Black children exhibited higher insulin dosages and lower SES compared to white children.
- Black children had significantly higher HbA1 levels, indicating poorer metabolic control, even after adjusting for insulin dose, diabetes duration, and SES.
- Black children experienced more frequent hospitalizations for DKA and missed more clinic visits than white children.
Conclusions:
- Black youth with T1DM are in poorer metabolic control compared to their white counterparts.
- Racial disparities in metabolic control are evident in pediatric T1DM, necessitating targeted interventions.
- Factors such as socioeconomic status and healthcare access may contribute to these disparities.
Objective:
This study evaluated racial differences in the metabolic control of children and adolescents with insulin-dependent (type I) diabetes mellitus and examined the interactive effects of race with age and sex.
Research Design And Methods:
Data on several demographic and clinical variables were obtained for 102 black and 108 white children, including the percentage of total HbA1, age, age at diagnosis, duration of diabetes, pubertal status, insulin dose (U.kg-1.day-1), body mass index, number of clinic visits kept and missed, number of hospitalizations for diabetic ketoacidosis (DKA) for the year, and socioeconomic status (SES).
Results:
Black children had higher insulin dosages (P less than 0.05) and lower SESs (P less than 0.001) than white children. HbA1 was higher in black than white children (P less than 0.01) after statistically adjusting for the effects of insulin dose, diabetes duration, and SES. With HbA1-based criteria, more black than white children were in poor and fewer in good metabolic control (P less than 0.001). Older children (greater than or equal to 13 yr) had higher HbA1 levels than younger (less than 13 yr) children (P less than 0.002), but there were no differences in HbA1 between males and females nor were there interactive effects of race, sex, and age-group. Black children were hospitalized for DKA more frequently than white children (P less than 0.04). More black than white children missed clinic visits (P less than 0.01), but they did not differ in number of visits kept.
Conclusions:
Black youths with type I diabetes mellitus are in poorer metabolic control than white youths.