Racial/Ethnic Minority Youth With Recent-Onset Type 1 Diabetes Have Poor Prognostic Factors.

Document Type

Article

Publication Date

5-2018

Identifier

DOI: 10.2337/dc17-2335

Abstract

Objective: To compare races/ethnicities for characteristics, at type 1 diabetes diagnosis and during the first 3 years postdiagnosis, known to influence long-term health outcomes.

Research design and methods: We analyzed 927 Pediatric Diabetes Consortium (PDC) participants <19 years old (631 non-Hispanic white [NHW], 216 Hispanic, and 80 African American [AA]) diagnosed with type 1 diabetes and followed for a median of 3.0 years (interquartile range 2.2-3.6). Demographic and clinical data were collected from medical records and patient/parent interviews. Partial remission period or "honeymoon" was defined as insulin dose-adjusted hemoglobin A1c (IDAA1c) ≤9.0%. We used logistic, linear, and multinomial regression models, as well as repeated-measures logistic and linear regression models. Models were adjusted for known confounders.

Results: AA subjects, compared with NHW, at diagnosis, were in a higher age- and sex-adjusted BMI percentile (BMI%), had more advanced pubertal development, and had higher frequency of presentation in diabetic ketoacidosis, largely explained by socioeconomic factors. During the first 3 years, AA subjects were more likely to have hypertension and severe hypoglycemia events; had trajectories with higher hemoglobin A1c, BMI%, insulin doses, and IDAA1c; and were less likely to enter the partial remission period. Hispanics, compared with NHWs, had higher BMI% at diagnosis and over the three subsequent years. During the 3 years postdiagnosis, Hispanics had higher prevalence of dyslipidemia and maintained trajectories of higher insulin doses and IDAA1c.

Conclusions: Youth of minority race/ethnicity have increased markers of poor prognosis of type 1 diabetes at diagnosis and 3 years postdiagnosis, possibly contributing to higher risk of long-term diabetes complications compared with NHWs.

Journal Title

Diabetes care

Volume

41

Issue

5

First Page

1017

Last Page

1024

MeSH Keywords

Adolescent; African Americans; Age of Onset; Child; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Ethnicity; Female; Glycated Hemoglobin A; Hispanic or Latino; Humans; Hypoglycemia; Insulin; Male; Minority Groups; Prognosis; Racial Groups; Socioeconomic Factors; Whites

Keywords

African Americans; Age of Onset; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Ethnicity; Glycated Hemoglobin A; Hispanic or Latino; Humans; Hypoglycemia; Insulin; Minority Groups; Prognosis; Racial Groups; Socioeconomic Factors; Whites

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