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Socioeconomic and Linguistic Factors in Paediatric Type 1 Diabetes: Exploring Glycemic Outcomes, Technology Use, and
Silvia Savastio1, Andrea E Scaramuzza2, Erica Pozzi1
1Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Insights
Children from migrant-background families with type 1 diabetes experienced worse glycemic control, including higher HbA1c and glycemic variability. Interventions addressing socioeconomic and linguistic disparities are crucial for improving outcomes.
Area of Science:
- Pediatric Endocrinology
- Diabetes Management
- Health Disparities
Background:
- Type 1 diabetes (T1D) management in children requires continuous monitoring and intervention.
- Migrant populations often face unique socioeconomic and linguistic challenges impacting health outcomes.
- Understanding these disparities is key to equitable T1D care.
Purpose of the Study:
- To examine the relationship between migrant status, socioeconomic factors (SES), and glycemic control in pediatric T1D.
- To assess residual beta-cell function and its association with outcomes in this population.
Main Methods:
- Retrospective analysis of 208 children with T1D (Italian and migrant-background families).
- Data collected included glucometric (HbA1c, Time in Range), SES (education, language, income), and metabolic parameters.
- Univariable and multivariable regression analyses were performed to identify factors associated with glycemic control.
Main Results:
- Children from migrant-background families presented with more severe ketoacidosis at diagnosis and had worse glycemic control (higher HbA1c, lower Time in Range, increased glycemic variability) despite higher use of advanced diabetes technology.
- Significant socioeconomic disparities were observed, with higher unemployment rates among mothers in migrant families.
- Migrant status was independently associated with higher HbA1c, while advanced diabetes technology use and higher maternal education correlated with better Time in Range.
Conclusions:
- Migrant children with T1D experience poorer glycemic outcomes, indicating that technology alone is insufficient to overcome socioeconomic and linguistic barriers.
- Targeted interventions focusing on education, language support, and enhancing family self-management capacity are essential for reducing disparities in T1D care.
- Further research should explore culturally sensitive strategies to improve glycemic control in diverse pediatric T1D populations.
Aims:
To investigate associations between migrant status, socioeconomic factors (SES), and residual beta-cell function and glycemic outcomes in paediatric type 1 diabetes.
Methods:
Retrospective study of 208 children (median [IQR] age 11 [8-14] years; 119 Italian, 89 from migrant-background families) with glucometric (HbA1c, TIR, TITR, TAR, CV), SES (maternal/paternal education, language, income), and metabolic data. Univariable and exploratory multivariable regression analyses identified factors associated with glycemic control.
Results:
Children from migrant-background families presented with more severe metabolic crisis at onset (pH 7.28 vs. 7.35, p = 0.047; C-peptide 0.24 vs. 0.32 ng/mL, p = 0.010). Despite higher AID usage (80.6% vs. 68.1%), children from migrant-background families showed significantly worse glycemic control: higher HbA1c (7.8% vs. 7.0%, p < 0.001), lower TIR (57% vs. 65%, p = 0.004), and greater glycemic variability (CV 39.3% vs. 35.0%, p < 0.001). Socioeconomic disparities were marked, with 63.4% of migrant mothers unemployed (vs 16.6%, p < 0.001). In multivariable analysis, migrant status was associated with higher HbA1c (β +0.70, p < 0.001), while AID use (β +10, p < 0.001) and high maternal education (β +7.86, p = 0.004) were associated with higher TIR.
Conclusions:
In this retrospective cohort, children and adolescents from migrant-background families had poorer glycemic outcomes despite high AID uptake and comparable C-peptide levels at follow-up. Technology provision alone may be insufficient to eliminate socioeconomic and linguistic disparities in glycemic control, and interventions targeting education, language support, and family-level self-management capacity may be beneficial.
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