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Disparities in Glycemic Outcomes Persist in Youth with Type 1 Diabetes and High-Technology Use
Meryl C Nath1, Blake Frey1, Joycelyn Atchison2
1UAB Heersink School of Medicine, Birmingham, AL 35233, USA.
Insights
Racial disparities in glycemic control persist in youth with Type 1 diabetes (T1D), even with continuous glucose monitoring (CGM). Race and diabetes duration significantly impact glycemic outcomes, independent of other factors.
Area of Science:
- Endocrinology and Metabolism
- Pediatric Diabetes Research
Background:
- Racial disparities are documented in glycemic outcomes for pediatric patients with Type 1 diabetes (T1D).
- Hemoglobin A1c (HbA1c) has limitations for comparing glycemic control across diverse patient groups due to individual variability.
Purpose of the Study:
- To compare continuous glucose monitoring (CGM) metrics with HbA1c levels in youth with T1D.
- To assess the influence of race, age, diabetes duration, insurance, and insulin pump use on glycemic control.
Main Methods:
- Analysis of data from 188 youth with T1D, utilizing Dexcom G6 CGM data and HbA1c.
- Inclusion criteria controlled for race, age, diabetes duration, insurance status, and insulin pump use.
- Multiple linear regression was employed to determine independent predictors of glycemic outcomes.
Main Results:
- Significant differences in HbA1c, mean glucose, and time above 250 mg/dL were observed between non-Hispanic White (NHW) and non-Hispanic Black (NHB) patients (p < 0.001).
- Regression analysis confirmed that race and diabetes duration were independently associated with glycemic outcomes.
- These factors remained significant predictors even after controlling for age, sex, insurance status, and insulin administration method.
Conclusions:
- Glycemic outcome disparities persist in youth with T1D using CGM and insulin pumps.
- Race is a significant independent predictor of glycemic control in this population.
- Findings underscore the need to address racial factors in managing T1D in adolescents.
Background:
Racial disparities are well described in glycemic outcomes in youth with Type 1 diabetes mellites (T1D). Hemoglobin A1c (HbA1c) has some limitations in comparing glycemia across patient groups as there are individual variations in mean glucose and HbA1c.
Objective:
This study aimed to compare glycemic metrics obtained from (Dexcom G6) continuous glucose monitor (CGM) device with HbA1c levels controlling for race, age, duration of diabetes, race, insurance status, and insulin pump use with glycemic control. Subjects and Methods. Data analyzed included 188 patients, majority non-Hispanic White (NHW) (n = 147, 78.2%) and majority privately insured (n = 147, 78.2%). Half of the patients were using insulin pumps, (n = 94, 50.0%) and approximately half were female. Median age was 16.6 (interquartile range: 14.2-18.2) years old with a median age of diabetes diagnosis at 9.3-years old.
Results:
Significant differences were observed between NHW and non-Hispanic Black (NHB) patients in terms of HbA1c, 90-day mean glucose, and 90-day time >250 mg/dL (>13.9 mmol/L) (7.6% vs. 9.2%, 181 mg/dL vs. 220 mg/dL, and 16.3% vs. 34.7%, respectively, p < 0.001 for all comparisons). Multiple linear regression analysis was performed to predict the influence of age, duration of diabetes, race, insurance status, and insulin administration on glycemic outcomes. Regression analysis revealed significant equations for all glycemic outcomes, demonstrating a strong correlation (p < 0.0001, p=0.0001, and p < 0.0001, respectively). However, after controlling for these variables, only race and duration of diabetes remained independently associated with glycemic outcomes, suggesting that these factors strongly influence glycemic control independent of age, sex, insurance, and pump use.
Conclusion:
Even in a subset of youth with T1D using CGM with high rates of insulin pump use, disparities in glycemic outcomes persist. When evaluating glycemic outcomes, race remained a significant cofactor despite controlling for age, duration of diabetes, sex, insurance status, and insulin administration type. These results add to the existing literature, and demonstrate race remains strong predictor of glycemic outcomes.
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