Racial and ethnic minority youths predisposed to poor diabetes prognosis
medwireNews: African–American and Hispanic adolescents are more likely than their non-Hispanic White peers to present with characteristics associated with poor long-term prognosis when they are first diagnosed with type 1 diabetes, research suggests.
“The poorer early trajectory may contribute to the increased risk of long-term complications of diabetes in minority youth in the U.S.,” say Robin Gal (Jaeb Center for Health Research, Tampa, Florida, USA) and co-investigators.
Therefore “[c]linicians should be alerted to their higher risk of specific comorbidities so that appropriate screening and management are implemented,” they add.
Gal et al report that, compared with the 631 non-Hispanic White study participants (mean age 9.2 years), the 80 African Americans (mean age 9.8 years) were in a higher age- and sex- adjusted BMI percentile (BMI%) at diagnosis (median 70 vs 43%) and were significantly more likely to have diabetic ketoacidosis (DKA) at presentation (48 vs 32%). They also had more advanced pubertal development with 24% at Tanner stage 5, compared with 5% of non-Hispanic White participants.
However, the increased prevalence of DKA among African Americans was largely attenuated and no longer statistically significant after adjustment for health insurance status.
The 216 Hispanic participants (mean age 9.2 years) were in a higher BMI% (median 64 vs 43%) at diagnosis than the non-Hispanic White participants, but were not more likely to present with DKA and had a similar pubertal status.
During the first 3 years postdiagnosis, both the African–American and Hispanic participants consistently had significantly higher BMI%, insulin doses, and insulin dose–adjusted glycated hemoglobin (HbA1c) than those in the non-Hispanic White group.
The trajectory for insulin dose–adjusted HbA1c was significantly higher among the African–American participants than among the non-Hispanic Whites, even after adjustment for age, sex, BMI, type of health insurance, parent education, and family income. The same was not true for Hispanics, for whom the association was attenuated upon adjustment.
Gal and team also found African–American individuals were more likely than non-Hispanic White individuals to have hypertension (15 vs 7%) and severe hypoglycemia events (11 vs 4%) and were less likely to enter partial remission at 6 months, defined as dose-adjusted HbA1c at or below 9.0% (28 vs 53%), while the Hispanic individuals had a higher prevalence of dyslipidemia (22 vs 12%).
Of note, there was also an increased risk for severe hypoglycemia among the Hispanic participants, but this was attenuated after adjustment for parent education.
The authors therefore say: “It will be important to conduct studies to address parent education as a potential mechanism for the increased frequency of severe hypoglycemia among minority children with type 1 diabetes.”
Writing in Diabetes Care, Gal and colleagues conclude that their data “underscore the importance of integrating race/ethnicity in predictive models for outcomes of interest to guide efforts to improve population health management.”
By Laura Cowen
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