Racial Disparities in the Care of Patients with Type 1 Diabetes: Results from a Multicenter Study in Brazil

There is little information available about the effect self-reported color/race has on glycemic control in patients with type 1 diabetes (T1D) in Brazil. Therefore, we aimed at evaluating the role of self-reported color/race on glycemic control and on the types of prescribed insulin in this population.

This was a cross-sectional study with 1760 patients with T1D with data collection between August 2011 and August 2014 in Brazil. An adjusted linear regression model was used to compare the hemoglobin A1c HbA1c) of patients who self-reported as Black and Brown to those who self-reported as White. Adjusted logistic regression models were used to evaluate the relationship between self-reported color-race and types of prescribed insulin.

Black patients presented a difference in HbA1c of 0·74% (p-value < 0·001) in the unadjusted model and of 0·58% (p-value 0·004) in the adjusted model compared to White patients. Black patients had 53% (95% CI: 26%-70%) and 66% (95% CI: 44%-79%) less odds of receiving analogues for bolus and basal insulin, respectively, than White patients in the adjusted models. Brown patients presented a difference in HbA1c of 0·42% (p-value < 0·001) in the crude model and 0.23% (p-value 0·04) in the adjusted model compared to White patients. Brown patients had 49% (95% CI: 35%-60%) and 43% (95% CI: 27%-55%) less odds of receiving analogues for bolus and basal insulin, respectively, in adjusted models than White patients.

Black and Brown Brazilian patients with T1D presented with higher HbA1c and received less advanced diabetes therapies compared to White patients.