Racial-Ethnic Inequity in Young Adults with Type 1 Diabetes
Agarwal S, Kanapka LG, Raymond JK, Walker A, Gerard-Gonzalez A, Kruger D, Redondo MJ, Rickels MR, Shah VN, Butler A, Gonzalez J, Verdejo AS, Gal RL, Willi S, and Long JA. Racial-Ethnic Inequity in Young Adults with Type 1 Diabetes. J Clin Endocrinol Metab 2020.
The Journal of clinical endocrinology and metabolism
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 multi-center collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between White, Black, and Hispanic YA and multi-level modeling to identify variables that account for glycemic disparity apart from SES.
SETTING: Six diabetes centers across the U.S.
PARTICIPANTS: 300 YA with T1D (18-28 yrs: 33% Non-Hispanic White, 32% Non-Hispanic Black, and 34% Hispanic).
MAIN OUTCOME: Racial-ethnic disparity in HbA1c levels.
RESULTS: Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than White YA (p<0.001). 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 White and Hispanic YA, while they remained for 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 Black-White glycemic disparity.
CONCLUSION: This study demonstrated large racial-ethnic inequity in YA with T1D, especially among 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 promote resilience.
ePub ahead of print