Racial-Ethnic Inequity in Young Adults With Type 1 Diabetes

Abstract Context Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. Objective To describe racial-ethnic disparities among YA wit...

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Vydáno v:	The journal of clinical endocrinology and metabolism Ročník 105; číslo 8; s. e2960 - e2969
Hlavní autoři:	Agarwal, Shivani, Kanapka, Lauren G, Raymond, Jennifer K, Walker, Ashby, Gerard-Gonzalez, Andrea, Kruger, Davida, Redondo, Maria J, Rickels, Michael R, Shah, Viral N, Butler, Ashley, Gonzalez, Jeffrey, Verdejo, Alandra S, Gal, Robin L, Willi, Steven, Long, Judith A
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	US Oxford University Press 01.08.2020
Témata:	Analysis Blood Glucose Self-Monitoring - instrumentation Blood Glucose Self-Monitoring - statistics & numerical data Continental Population Groups - statistics & numerical data Cross-Sectional Studies Diabetes Mellitus, Type 1 - blood Diabetes Mellitus, Type 1 - diagnosis Diabetes Mellitus, Type 1 - epidemiology Diabetes Mellitus, Type 1 - therapy Discrimination in medical care Ethnic Groups - statistics & numerical data Female Glycated Hemoglobin A - analysis Glycosylated hemoglobin Health care disparities Health Status Disparities Humans Male Minority Groups - statistics & numerical data Online Only Patient Compliance - statistics & numerical data Self-care, Health Self-Management - statistics & numerical data Social Class Social Determinants of Health - statistics & numerical data Teenagers Type 1 diabetes United States Young Adult Youth United States type 1 diabetes social determinants of health healthcare disparities inequity young adults
ISSN:	0021-972X, 1945-7197, 1945-7197
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Abstract	Abstract Context Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. Objective To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES). Design Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES. Setting Six diabetes centers across the United States. Participants A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic). Main Outcome Racial-ethnic disparity in HbA1c levels. Results Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black–White glycemic disparity. Conclusion This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors.
AbstractList	Context: Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. Objective: To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES). Design: Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES. Setting: Six diabetes centers across the United States. Participants: A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% nonHispanic Black, and 34% Hispanic). Main Outcome: Racial-ethnic disparity in HbA1c levels. Results: Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between nonHispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black-White glycemic disparity. Conclusion: This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors. (J Clin Endocrinol Metab 105: 1-10, 2020) Key Words: type 1 diabetes, young adults, healthcare disparities, inequity, social determinants of health Abstract Context Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. Objective To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES). Design Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES. Setting Six diabetes centers across the United States. Participants A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic). Main Outcome Racial-ethnic disparity in HbA1c levels. Results Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black–White glycemic disparity. Conclusion This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors. Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES). Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES. Six diabetes centers across the United States. A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic). Racial-ethnic disparity in HbA1c levels. Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black-White glycemic disparity. This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors. Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied.CONTEXTMinority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied.To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES).OBJECTIVETo describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES).Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES.DESIGNCross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES.Six diabetes centers across the United States.SETTINGSix diabetes centers across the United States.A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic).PARTICIPANTSA total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic).Racial-ethnic disparity in HbA1c levels.MAIN OUTCOMERacial-ethnic disparity in HbA1c levels.Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black-White glycemic disparity.RESULTSNon-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black-White glycemic disparity.This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors.CONCLUSIONThis study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors.
Audience	Academic
Author	Gonzalez, Jeffrey Gal, Robin L Walker, Ashby Kanapka, Lauren G Gerard-Gonzalez, Andrea Kruger, Davida Shah, Viral N Verdejo, Alandra S Agarwal, Shivani Redondo, Maria J Long, Judith A Rickels, Michael R Raymond, Jennifer K Willi, Steven Butler, Ashley
AuthorAffiliation	2 Jaeb Center for Health Research , Tampa, FL 3 Children’s Hospital Los Angeles , Los Angeles, CA 6 Henry Ford Medical Center , Detroit, MI 7 Baylor College of Medicine, Texas Children’s Hospital , Houston, TX 8 Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA 9 Ferkauf Graduate School of Psychology, Yeshiva University , Bronx, NY 5 Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus , Aurora, CO 1 Fleischer Institute for Diabetes and Metabolism, New York-Regional Center for Diabetes Translational Research, Division of Endocrinology, Albert Einstein College of Medicine , Bronx, NY 10 Children’s Hospital of Philadelphia , Philadelphia, PA 4 University of Florida , Gainesville, FL 11 Corporal Michael J. Crescenz VA Medical Center , Philadelphia, PA
AuthorAffiliation_xml	– name: 3 Children’s Hospital Los Angeles , Los Angeles, CA – name: 6 Henry Ford Medical Center , Detroit, MI – name: 8 Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine , Philadelphia, PA – name: 11 Corporal Michael J. Crescenz VA Medical Center , Philadelphia, PA – name: 1 Fleischer Institute for Diabetes and Metabolism, New York-Regional Center for Diabetes Translational Research, Division of Endocrinology, Albert Einstein College of Medicine , Bronx, NY – name: 2 Jaeb Center for Health Research , Tampa, FL – name: 5 Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus , Aurora, CO – name: 4 University of Florida , Gainesville, FL – name: 10 Children’s Hospital of Philadelphia , Philadelphia, PA – name: 7 Baylor College of Medicine, Texas Children’s Hospital , Houston, TX – name: 9 Ferkauf Graduate School of Psychology, Yeshiva University , Bronx, NY
Author_xml	– sequence: 1 givenname: Shivani orcidid: 0000-0003-4506-3702 surname: Agarwal fullname: Agarwal, Shivani email: Shivani.Agarwal@einsteinmed.org organization: Fleischer Institute for Diabetes and Metabolism, New York-Regional Center for Diabetes Translational Research, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY – sequence: 2 givenname: Lauren G surname: Kanapka fullname: Kanapka, Lauren G organization: Jaeb Center for Health Research, Tampa, FL – sequence: 3 givenname: Jennifer K surname: Raymond fullname: Raymond, Jennifer K organization: Children’s Hospital Los Angeles, Los Angeles, CA – sequence: 4 givenname: Ashby surname: Walker fullname: Walker, Ashby organization: University of Florida, Gainesville, FL – sequence: 5 givenname: Andrea surname: Gerard-Gonzalez fullname: Gerard-Gonzalez, Andrea organization: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO – sequence: 6 givenname: Davida surname: Kruger fullname: Kruger, Davida organization: Henry Ford Medical Center, Detroit, MI – sequence: 7 givenname: Maria J surname: Redondo fullname: Redondo, Maria J organization: Baylor College of Medicine, Texas Children’s Hospital, Houston, TX – sequence: 8 givenname: Michael R surname: Rickels fullname: Rickels, Michael R organization: Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA – sequence: 9 givenname: Viral N surname: Shah fullname: Shah, Viral N organization: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO – sequence: 10 givenname: Ashley surname: Butler fullname: Butler, Ashley organization: Baylor College of Medicine, Texas Children’s Hospital, Houston, TX – sequence: 11 givenname: Jeffrey surname: Gonzalez fullname: Gonzalez, Jeffrey organization: Fleischer Institute for Diabetes and Metabolism, New York-Regional Center for Diabetes Translational Research, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY – sequence: 12 givenname: Alandra S surname: Verdejo fullname: Verdejo, Alandra S organization: Jaeb Center for Health Research, Tampa, FL – sequence: 13 givenname: Robin L surname: Gal fullname: Gal, Robin L organization: Jaeb Center for Health Research, Tampa, FL – sequence: 14 givenname: Steven surname: Willi fullname: Willi, Steven organization: Children’s Hospital of Philadelphia, Philadelphia, PA – sequence: 15 givenname: Judith A surname: Long fullname: Long, Judith A organization: Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/32382736$$D View this record in MEDLINE/PubMed
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ContentType	Journal Article
Copyright	Endocrine Society 2020. 2020 Endocrine Society 2020. COPYRIGHT 2020 Oxford University Press
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childhood abuse and household dysfunction to many of the leading causes of death in adults publication-title: Am J Prev Med doi: 10.1016/S0749-3797(98)00017-8 – year: 2020 ident: 2021122109212717600_CIT0023 article-title: Supplemental tables for “Racial-Ethnic Inequity in Young Adults With Type 1 Diabetes.” publication-title: Dryad
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Snippet	Abstract Context Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes.... Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers... Context: Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable...
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SubjectTerms	Analysis Blood Glucose Self-Monitoring - instrumentation Blood Glucose Self-Monitoring - statistics & numerical data Continental Population Groups - statistics & numerical data Cross-Sectional Studies Diabetes Mellitus, Type 1 - blood Diabetes Mellitus, Type 1 - diagnosis Diabetes Mellitus, Type 1 - epidemiology Diabetes Mellitus, Type 1 - therapy Discrimination in medical care Ethnic Groups - statistics & numerical data Female Glycated Hemoglobin A - analysis Glycosylated hemoglobin Health care disparities Health Status Disparities Humans Male Minority Groups - statistics & numerical data Online Only Patient Compliance - statistics & numerical data Self-care, Health Self-Management - statistics & numerical data Social Class Social Determinants of Health - statistics & numerical data Teenagers Type 1 diabetes United States Young Adult Youth
Title	Racial-Ethnic Inequity in Young Adults With Type 1 Diabetes
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