OBJECTIVEInsulin resistance is greater in racial/ethnic minorities than in non-Hispanic whites (NHWs) for those with and without type 2 diabetes. Because previous research on insulin resistance in type 1 diabetes was limited to NHWs, racial/ethnic variation in an estimated measure of insulin resistance in type 1 diabetes was determined.RESEARCH DESIGN AND METHODSThe sample included 79 individuals with type 1 diabetes diagnosed at age <18 years (32.9% NHWs, 46.8% non-Hispanic black [NHB], 7.6% other/mixed, and 12.7% Hispanic) and their families. Estimated glucose disposal rate (eGDR) (milligrams per kilogram per minute; a lower eGDR indicates greater insulin resistance) was calculated using A1C, waist circumference, and hypertension status.RESULTSMean current age was 13.5 years (range 3.2–32.5) and diabetes duration was 5.7 years (0.1–19.9). eGDR was inversely associated with age. Compared with that in NHWs, age-adjusted eGDR was significantly lower among nonwhites (NHB, other/mixed, and Hispanic: Δ = −1.83, P = 0.0006). Age-adjusted eGDR was negatively associated with body fat, triglycerides, urinary albumin/creatinine, acanthosis nigricans, parental obesity, and parental insulin resistance and positively related to HDL and sex hormone–binding globulin. In multivariable analysis, lower eGDR was significantly associated with older age, nonwhite race/ethnicity, acanthosis, and lower HDL.CONCLUSIONSMinorities with type 1 diabetes are significantly more insulin resistant, as measured by eGDR, than NHWs. Exploring potential mechanisms, including disparities in care and/or physiological variation, may contribute to preventing racial/ethnic differences in insulin resistance–associated outcomes.

Objective We examined sleep in families of individuals with type 1 diabetes and the relationship of sleep with obesity, diabetes, and insulin resistance. Methods Probands with type 1 diabetes diagnosed before age 18 and 1st and 2nd degree relatives were included (n = 323). Demographic, anthropometric and clinical variables and self-reported sleep duration and napping were assessed. Results On average, adults (≥ 20 years) slept 7.5 (SD 1.5) hr, whereas children (5–11 years) and adolescents (12–19 years) slept 9.8 (SD 1.1) and 8.5 (SD 1.9) hr, respectively (p < .01). Based on national recommendations, 40.9% of participants slept insufficiently, particularly young people (vs. adults, p < .01). In age-group stratified analysis, there were no significant associations of insufficient sleep or sleep duration with obesity, diabetes status, or insulin resistance after adjustment for age, race/ethnicity, and gender. 42% of participants reported napping regularly (≥ 1/week), with adolescents significantly more likely to do so (vs. adults, OR = 1.95, p < .01). Non-Hispanic Blacks and Hispanics also had higher odds of regular napping (vs. Non-Hispanic Whites, OR = 3.74, p < .01, and OR = 2.52, p = .03, respectively). In adjusted analysis, leaner (vs. obese) adolescents, whether measured by body mass index, percent body fat, or waist circumference, were significantly more likely to nap regularly. Conclusions We found that insufficient sleep was significantly more likely in children and adolescents compared with adults in families with type 1 diabetes. Lower adiposity was associated with regular napping in adolescents. The high prevalence of insufficient sleep in young patients with type 1 diabetes and their relatives detected in the current study may have significant health consequences.

OBJECTIVES Rehospitalization after a diabetes diagnosis in youth signals the failure of outpatient management. We examined risk factors for rehospitalization among young patients with diabetes. PATIENTS AND METHODS We queried 535 participants diagnosed before 18 years of age from the Chicago Childhood Diabetes Registry. Demographic, social, and clinical data were used in logistic models of diabetes-related rehospitalization, as well as, among those rehospitalized, frequent (≥ once per 2 years’ duration) versus infrequent rehospitalization rates. RESULTS Mean (range) duration was 5.1 years (0.1–19.2 years). The sample was 55% non-Hispanic black, 11% non-Hispanic white, 26% Hispanic, and 7% other/mixed race; 86% had presumed type 1 diabetes; and 47% were underinsured. Overall, 46% reported rehospitalization for diabetes. In multivariable logistic regression, ever being rehospitalized was significantly associated with diabetes duration (per year, odds ratio [OR]: 1.26; P < .01), female gender (OR: 1.67; P = .01), underinsurance (versus private insurance; OR: 1.79; P < .01), presumed phenotype (non–type 1 diabetes versus type 1; OR: 0.32; P < .01), and diagnosis at a community hospital (versus tertiary care facility; OR: 1.96; P < .01) and tended to be higher for those of nonwhite race (OR: 1.94; P = .07). Among those rehospitalized, multivariable associations with frequent rehospitalization were presumed phenotype (non–type 1 diabetes versus type 1; OR: 2.74; P = .04), head of house hold not working (versus employed; OR: 1.88; P = .02), and younger age at questionnaire (per year; OR: 0.94; P = .01). CONCLUSIONS Rehospitalization is common in young patients with diabetes, especially for those with limited resources, indicating the need for improved outpatient services. Comprehensive initial education and support available to young patients with diabetes diagnosed at tertiary care facilities and their families may have lasting protective effects.