Racial-ethnic disparities in management and outcomes among children with type 1 diabetes

Steven M. Willi, Kellee M. Miller, Linda A. DiMeglio, Georgeanna J. Klingensmith, Jill H. Simmons, William V. Tamborlane, Kristen J. Nadeau, Julie M. Kittelsrud, Peter Huckfeldt, Roy W. Beck, Terri H. Lipman

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Previous research has documented racial/ethnic disparities in diabetes treatments and outcomes. It remains controversial whether these disparities result from differences in socioeconomic status (SES) or other factors. We examined racial/ethnic disparities in therapeutic modalities and diabetes outcomes among the large number of pediatric participants in the T1D Exchange Clinic Registry. METHODS: The cohort included 10 704 participants aged <18 years with type 1 diabetes for ≥1 year (48% female; mean age: 11.9 ± 3.6 years; diabetes duration: 5.2 ± 3.5 years). Diabetes management and clinical outcomes were compared among 8841 non-Hispanic white (white) (83%), 697 non-Hispanic black (black) (7%), and 1166 Hispanic (11%) participants. The population included 214 high-income black and Hispanic families. RESULTS: Insulin pump use was higher in white participants than in black or Hispanic participants (61% vs 26% and 39%, respectively) after adjusting for gender, age, diabetes duration, and SES (P < .001). Mean hemoglobin A1c was higher (adjusted P < .001) in black participants than in white or Hispanic participants (9.6%, 8.4%, and 8.7%). More black participants experienced diabetic ketoacidosis and severe hypoglycemic events in the previous year than white or Hispanic participants (both, P < .001). There were no significant differences in hemoglobin A1c, diabetic ketoacidosis, or severe hypoglycemia between white and Hispanic participants after adjustment for SES. CONCLUSIONS: Even after SES adjustment, marked disparities in insulin treatment method and treatment outcomes existed between black versus Hispanic and white children within this large pediatric cohort. Barriers to insulin pump use and optimal glycemic control beyond SES should be explored in all ethnic groups.

Original languageEnglish (US)
Pages (from-to)424-434
Number of pages11
JournalPediatrics
Volume135
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Type 1 Diabetes Mellitus
Hispanic Americans
Social Class
Diabetic Ketoacidosis
Insulin
Hemoglobins
Pediatrics
Social Adjustment
Ethnic Groups
Hypoglycemia
Hypoglycemic Agents
Registries
Therapeutics
Research
Population

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Willi, S. M., Miller, K. M., DiMeglio, L. A., Klingensmith, G. J., Simmons, J. H., Tamborlane, W. V., ... Lipman, T. H. (2015). Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics, 135(3), 424-434. https://doi.org/10.1542/peds.2014-1774

Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. / Willi, Steven M.; Miller, Kellee M.; DiMeglio, Linda A.; Klingensmith, Georgeanna J.; Simmons, Jill H.; Tamborlane, William V.; Nadeau, Kristen J.; Kittelsrud, Julie M.; Huckfeldt, Peter; Beck, Roy W.; Lipman, Terri H.

In: Pediatrics, Vol. 135, No. 3, 01.03.2015, p. 424-434.

Research output: Contribution to journalArticle

Willi, SM, Miller, KM, DiMeglio, LA, Klingensmith, GJ, Simmons, JH, Tamborlane, WV, Nadeau, KJ, Kittelsrud, JM, Huckfeldt, P, Beck, RW & Lipman, TH 2015, 'Racial-ethnic disparities in management and outcomes among children with type 1 diabetes', Pediatrics, vol. 135, no. 3, pp. 424-434. https://doi.org/10.1542/peds.2014-1774
Willi SM, Miller KM, DiMeglio LA, Klingensmith GJ, Simmons JH, Tamborlane WV et al. Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics. 2015 Mar 1;135(3):424-434. https://doi.org/10.1542/peds.2014-1774
Willi, Steven M. ; Miller, Kellee M. ; DiMeglio, Linda A. ; Klingensmith, Georgeanna J. ; Simmons, Jill H. ; Tamborlane, William V. ; Nadeau, Kristen J. ; Kittelsrud, Julie M. ; Huckfeldt, Peter ; Beck, Roy W. ; Lipman, Terri H. / Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. In: Pediatrics. 2015 ; Vol. 135, No. 3. pp. 424-434.
@article{d0253496b3e24943b4d19365db249249,
title = "Racial-ethnic disparities in management and outcomes among children with type 1 diabetes",
abstract = "BACKGROUND AND OBJECTIVES: Previous research has documented racial/ethnic disparities in diabetes treatments and outcomes. It remains controversial whether these disparities result from differences in socioeconomic status (SES) or other factors. We examined racial/ethnic disparities in therapeutic modalities and diabetes outcomes among the large number of pediatric participants in the T1D Exchange Clinic Registry. METHODS: The cohort included 10 704 participants aged <18 years with type 1 diabetes for ≥1 year (48{\%} female; mean age: 11.9 ± 3.6 years; diabetes duration: 5.2 ± 3.5 years). Diabetes management and clinical outcomes were compared among 8841 non-Hispanic white (white) (83{\%}), 697 non-Hispanic black (black) (7{\%}), and 1166 Hispanic (11{\%}) participants. The population included 214 high-income black and Hispanic families. RESULTS: Insulin pump use was higher in white participants than in black or Hispanic participants (61{\%} vs 26{\%} and 39{\%}, respectively) after adjusting for gender, age, diabetes duration, and SES (P < .001). Mean hemoglobin A1c was higher (adjusted P < .001) in black participants than in white or Hispanic participants (9.6{\%}, 8.4{\%}, and 8.7{\%}). More black participants experienced diabetic ketoacidosis and severe hypoglycemic events in the previous year than white or Hispanic participants (both, P < .001). There were no significant differences in hemoglobin A1c, diabetic ketoacidosis, or severe hypoglycemia between white and Hispanic participants after adjustment for SES. CONCLUSIONS: Even after SES adjustment, marked disparities in insulin treatment method and treatment outcomes existed between black versus Hispanic and white children within this large pediatric cohort. Barriers to insulin pump use and optimal glycemic control beyond SES should be explored in all ethnic groups.",
author = "Willi, {Steven M.} and Miller, {Kellee M.} and DiMeglio, {Linda A.} and Klingensmith, {Georgeanna J.} and Simmons, {Jill H.} and Tamborlane, {William V.} and Nadeau, {Kristen J.} and Kittelsrud, {Julie M.} and Peter Huckfeldt and Beck, {Roy W.} and Lipman, {Terri H.}",
year = "2015",
month = "3",
day = "1",
doi = "10.1542/peds.2014-1774",
language = "English (US)",
volume = "135",
pages = "424--434",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "3",

}

TY - JOUR

T1 - Racial-ethnic disparities in management and outcomes among children with type 1 diabetes

AU - Willi, Steven M.

AU - Miller, Kellee M.

AU - DiMeglio, Linda A.

AU - Klingensmith, Georgeanna J.

AU - Simmons, Jill H.

AU - Tamborlane, William V.

AU - Nadeau, Kristen J.

AU - Kittelsrud, Julie M.

AU - Huckfeldt, Peter

AU - Beck, Roy W.

AU - Lipman, Terri H.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - BACKGROUND AND OBJECTIVES: Previous research has documented racial/ethnic disparities in diabetes treatments and outcomes. It remains controversial whether these disparities result from differences in socioeconomic status (SES) or other factors. We examined racial/ethnic disparities in therapeutic modalities and diabetes outcomes among the large number of pediatric participants in the T1D Exchange Clinic Registry. METHODS: The cohort included 10 704 participants aged <18 years with type 1 diabetes for ≥1 year (48% female; mean age: 11.9 ± 3.6 years; diabetes duration: 5.2 ± 3.5 years). Diabetes management and clinical outcomes were compared among 8841 non-Hispanic white (white) (83%), 697 non-Hispanic black (black) (7%), and 1166 Hispanic (11%) participants. The population included 214 high-income black and Hispanic families. RESULTS: Insulin pump use was higher in white participants than in black or Hispanic participants (61% vs 26% and 39%, respectively) after adjusting for gender, age, diabetes duration, and SES (P < .001). Mean hemoglobin A1c was higher (adjusted P < .001) in black participants than in white or Hispanic participants (9.6%, 8.4%, and 8.7%). More black participants experienced diabetic ketoacidosis and severe hypoglycemic events in the previous year than white or Hispanic participants (both, P < .001). There were no significant differences in hemoglobin A1c, diabetic ketoacidosis, or severe hypoglycemia between white and Hispanic participants after adjustment for SES. CONCLUSIONS: Even after SES adjustment, marked disparities in insulin treatment method and treatment outcomes existed between black versus Hispanic and white children within this large pediatric cohort. Barriers to insulin pump use and optimal glycemic control beyond SES should be explored in all ethnic groups.

AB - BACKGROUND AND OBJECTIVES: Previous research has documented racial/ethnic disparities in diabetes treatments and outcomes. It remains controversial whether these disparities result from differences in socioeconomic status (SES) or other factors. We examined racial/ethnic disparities in therapeutic modalities and diabetes outcomes among the large number of pediatric participants in the T1D Exchange Clinic Registry. METHODS: The cohort included 10 704 participants aged <18 years with type 1 diabetes for ≥1 year (48% female; mean age: 11.9 ± 3.6 years; diabetes duration: 5.2 ± 3.5 years). Diabetes management and clinical outcomes were compared among 8841 non-Hispanic white (white) (83%), 697 non-Hispanic black (black) (7%), and 1166 Hispanic (11%) participants. The population included 214 high-income black and Hispanic families. RESULTS: Insulin pump use was higher in white participants than in black or Hispanic participants (61% vs 26% and 39%, respectively) after adjusting for gender, age, diabetes duration, and SES (P < .001). Mean hemoglobin A1c was higher (adjusted P < .001) in black participants than in white or Hispanic participants (9.6%, 8.4%, and 8.7%). More black participants experienced diabetic ketoacidosis and severe hypoglycemic events in the previous year than white or Hispanic participants (both, P < .001). There were no significant differences in hemoglobin A1c, diabetic ketoacidosis, or severe hypoglycemia between white and Hispanic participants after adjustment for SES. CONCLUSIONS: Even after SES adjustment, marked disparities in insulin treatment method and treatment outcomes existed between black versus Hispanic and white children within this large pediatric cohort. Barriers to insulin pump use and optimal glycemic control beyond SES should be explored in all ethnic groups.

UR - http://www.scopus.com/inward/record.url?scp=84924290699&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84924290699&partnerID=8YFLogxK

U2 - 10.1542/peds.2014-1774

DO - 10.1542/peds.2014-1774

M3 - Article

C2 - 25687140

AN - SCOPUS:84924290699

VL - 135

SP - 424

EP - 434

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 3

ER -