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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Veröffentlicht in:The journal of clinical endocrinology and metabolism Jg. 105; H. 8; S. e2960 - e2969
Hauptverfasser: 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
Format: Journal Article
Sprache:Englisch
Veröffentlicht: US Oxford University Press 01.08.2020
Schlagworte:
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
Online-Zugang:Volltext
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Zusammenfassung: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.
Bibliographie:ObjectType-Article-2
SourceType-Scholarly Journals-1
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ISSN:0021-972X
1945-7197
1945-7197
DOI:10.1210/clinem/dgaa236