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Children with type 1-diabetes from ethnic minorities: vulnerable patients needing a tailored medical support
Maurizio Vanelli1, Antonina Marta Cangelosi, Lavinia Fanciullo
1Regional Center for Children and Adolescents with Diabetes, Children Hospital, University Hospital, Parma, Italy. maurizio.vanelli@unipr.it
Insights
Children from ethnic minorities with type 1 diabetes (T1D) experience poorer metabolic control due to cultural and socioeconomic barriers. Addressing these disparities is crucial for equitable diabetes management in pediatric care.
Area of Science:
- Pediatric Endocrinology
- Diabetes Mellitus Research
- Public Health and Epidemiology
Background:
- Ethnic minority children with newly diagnosed type 1 diabetes (T1D) are at increased risk for poor metabolic control.
- Existing research indicates disparities in diabetes management outcomes between minority and native pediatric populations.
Purpose of the Study:
- To investigate the barriers contributing to suboptimal metabolic control in ethnic minority children with T1D.
- To compare the metabolic outcomes and healthcare utilization of ethnic minority children with T1D against their native peers.
Main Methods:
- A comparative study involving 35 ethnic minority children (Group 1) and 30 matched native children (Group 2) with T1D.
- Data collected included clinical parameters (HbA1c, DKA severity), treatment details, healthcare access, and family-reported challenges via questionnaires.
- Analysis focused on differences in metabolic control, hospital admissions, treatment costs, and monitoring practices.
Main Results:
- Ethnic minority children exhibited significantly higher HbA1c levels at diagnosis and cumulatively compared to native children.
- Group 1 experienced more severe diabetic ketoacidosis (DKA) at diagnosis, longer hospital stays, and higher treatment costs.
- Barriers identified included discontinuous glucose monitoring, missed clinic visits, and a need for culturally tailored educational materials.
Conclusions:
- Children with T1D from ethnic minorities face significant challenges in achieving metabolic targets.
- Cultural, educational, and economic factors negatively impact family life and diabetes management for these children.
- Targeted interventions and culturally sensitive support are essential to improve diabetes outcomes in minority pediatric populations.
Background And Aim:
Newly diagnosed children with type 1 diabetes from ethnic minorities are a growing presence in outpatient pediatric clinics, and are reported as a group at risk of poor metabolic control. In the present study we investigated the barriers affecting chances of minority diabetic children to achieve the same metabolic targets of native peers with type 1 diabetes.
Materials And Methods:
The study investigated 35 children from ethnic minorities (group 1) admitted to the Children University Hospital of Parma, Italy, from 1st January 2000 to December 31st, 2011, and data concerning current age, gender, ethnicity, age at diabetes onset, HbA1c, DKA severity degree at diagnosis, insulin therapy, annual number of out patient clinic visits, number of admissions for acute decompensation, and treatment cost. A short questionnaire on background, family situation, difficulties in diabetes monitoring, and outpatient clinic procedures completed the study. The results were compared with data collected from 30 matched native peers (group 2).
Results:
Mean HbA1c level at admittance was higher in Group 1 (11.8 +/- 1.0%) than in Group 2 (9.0 +/- 2.2%; p=0.000). The differences were confirmed when HbAlc mean cumulative values (8.6 +/- 2.1 vs 7.6 +/- 1.1; p=0.022) were calculated. Group 1 children at admission showed poorer metabolic conditions and longer stay at hospital (16 +/- 3 days) than Group 2 patients (8 +/- 2 days; p=0.000). The total costs for DKA treatment and family education resulted higher in group 1 (+54%) than in group 2 patients. Discontinuous capillary blood glucose monitoring and outpatient clinic visits missed were more frequent in Group 1 than in group 2 patients. Thirteen patients in group 1 needed a re-admittance to hospital because of a hypoglycemia (5 cases) or a hyperglycemia (8 cases). The same episodes were not recorded in group 2 patients. Most of parents expressed the wish to be supported with educational material in their own language.
Conclusions:
Children with TDM belonging to an ethnic minority had poorer metabolic control compared with native patients. This results from several cultural, educational, economic deficiencies which influence their family life and probably reduced their chances to obtain a better control.
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