Objective The aim of this study was to assess racial disparities in treatments and outcomes between Non‐Hispanic black (NHB), Hispanic and Non‐Hispanic white (NHW) children with type 1 diabetes (T1D). Methods We reviewed electronic health records of children (<18 years) attending a large, pediatric tertiary care diabetes center in the United States between October 1, 2018, and December 31, 2019. Health care utilization (appointment attendance, ED visits, hospitalizations), technology use (insulin pumps, continuous glucose monitors [CGM]) and hemoglobin A1c (HbA1c) were examined for each race/ethnicity and stratified by insurance type (private/government) as a proxy for socioeconomic status (SES). Results Of 1331 children (47% female) with a median (IQR) age of 14.2 (11.5, 16.3) years and T1D duration of 5.8 (3.8, 9) years; 1026 (77%) were NHW, 198 (15%) NHB, and 107 (8%) Hispanic. Government insurance was used by 358 (27%) children, representing 60% of NHB and 53% of Hispanic, but only 18% of NHW children. NHB children had higher HbA1c, more ED visits and hospitalizations, and were less likely to be treated with insulin pumps or CGM than NHW children (P < .001 for all). There were no racial disparities with regard to the number of appointments attended. Conclusions Racial disparities in technology use and diabetes outcomes persist in children with T1D, regardless of insurance status. To ensure equitable care, pediatric healthcare providers should remain cognizant of racial disparities in diabetes treatment. The impact of provider and patient factors should be explored when studying the etiology of these health disparities.

No abstract

No abstract

Depression symptoms are common for youth with diabetes and may negatively affect quality of life and health outcomes. In our large, urban, pediatric diabetes clinic, depression screening with a condensed, verbally-administered measure, the Patient Health Questionnaire-2 (PHQ-2), had a positivity rate of only 2%, which is far below anticipated rates. We developed a quality improvement project to increase the sensitivity of depression screening for youth with diabetes. The primary test of change was electronically administering the Patient Health Questionnaire for Adolescents (PHQ-A), a 13-question survey validated for use in pediatrics. Youths ≥ 12 years of age were asked to privately complete the PHQ-A on a laptop at a diabetes visit annually. Responses populated within the electronic health record, and medical providers were trained to respond to positive screens with the support of a social worker or psychologist. A run chart was used to assess screen-positivity rate over time; ≥6 points above the baseline was considered a significant change. During the study period (August 2018—February 2020), 740 PHQ-A screens were completed by 618 patients. The majority of patients (n = 489; 79%) had type 1 diabetes, 50% were female, and the median age (IQR) at screening was 16.2 (14.0-18.0) years. On average, 38.9 screens/month were completed (range: 16-70), and 6.8 screens/month were positive (range: 0-16). Of all completed screens, 129 (17.4%) were positive. The positivity rate was greater than baseline for all 7 quarters evaluated after implementation of PHQ-A. Of the positive screens, 55 (43%) were positive due only to SI or SA history. Using a standardized and easily administered approach, the detection of depression symptoms increased to a range comparable to previous reports. The number of completed screens per month was manageable, allowing us to promptly address depression symptoms within our interdisciplinary clinic workflow. Disclosure J. Gettings: None. S. M. Willi: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Medtronic, Other Relationship; Self; National Institute of Diabetes and Digestive and Kidney Diseases. O. Patil: None. M. Vajravelu: None. C. P. Hawkes: None. A. Tuttle: None. M. Buzby: None. S. Crean: None. M. B. Dever: None. L. Mulligan: None.