Racial-Ethnic Inequity in Young Adults With Type 1 Diabetes.
Blood Glucose Self-Monitoring
/ instrumentation
Cross-Sectional Studies
Diabetes Mellitus, Type 1
/ blood
Ethnicity
/ statistics & numerical data
Female
Glycated Hemoglobin
/ analysis
Health Status Disparities
Humans
Male
Minority Groups
/ statistics & numerical data
Patient Compliance
/ statistics & numerical data
Racial Groups
/ statistics & numerical data
Self-Management
/ statistics & numerical data
Social Class
Social Determinants of Health
/ statistics & numerical data
United States
Young Adult
healthcare disparities
inequity
social determinants of health
type 1 diabetes
young adults
Journal
The Journal of clinical endocrinology and metabolism
ISSN: 1945-7197
Titre abrégé: J Clin Endocrinol Metab
Pays: United States
ID NLM: 0375362
Informations de publication
Date de publication:
01 08 2020
01 08 2020
Historique:
received:
04
02
2020
accepted:
05
05
2020
pubmed:
10
5
2020
medline:
9
2
2021
entrez:
9
5
2020
Statut:
ppublish
Résumé
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.
Identifiants
pubmed: 32382736
pii: 5834375
doi: 10.1210/clinem/dgaa236
pmc: PMC7457963
pii:
doi:
Substances chimiques
Glycated Hemoglobin A
0
hemoglobin A1c protein, human
0
Types de publication
Comparative Study
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIDDK NIH HHS
ID : K23 DK115896
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK020541
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK111022
Pays : United States
Organisme : NIDDK NIH HHS
ID : P60 DK020541
Pays : United States
Informations de copyright
© Endocrine Society 2020.
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