Diabetes distress and HbA1c in racially/ethnically and socioeconomically diverse youth with type 1 diabetes

Abstract

Background: Diabetes distress, the emotional burden of caring for the chronic demands of diabetes, has not been well described in children and preadolescents with type 1 diabetes (T1D). This gap is particularly evident among youth of lower socioeconomic status (SES) and/or racial/ethnic minorities. Since these groups are more likely to have disparities in health outcomes and healthcare related to their diabetes, factors that could potentially improve glycemic and other diabetes-related outcomes should be studied closely. Objective: We hypothesized that (a) diabetes distress levels would be elevated in children with markers of lower SES and those of racial/ethnic minorities, and (b) higher HbA1c would be predicted by higher diabetes distress levels, when controlling for race/ethnicity, SES, and clinical covariates. Methods: One hundred and eighty-seven youth age 9 to 13 with T1D completed age-appropriate Problem Areas in Diabetes (PAID) questionnaires using a web-based portal during routine diabetes care visits. Results: PAID scores were significantly elevated in youth who had surrogate markers of lower SES and who were from racial/ethnic minority backgrounds. In multivariate models including race/ethnicity or the SES variables and controlling for clinical covariates, the factor most predictive of higher HbA1c was elevated PAID score. Conclusions: Diabetes distress is elevated in a younger population of children with T1D who are from racial/ethnic minority backgrounds or have markers of lower SES. Interventions that target distress and/or expand the safety net in these populations could potentially improve glycemic outcomes.

Precision medicine in type 1 diabetes

“…Distinct from depression, diabetes distress [135,136] is also common in diabetes [137] and is a product of emotional adjustment to the demands of diabetes. Diabetes distress has been found to be significantly associated with higher HbA 1c levels [138], with a recent study demonstrating that this was pronounced in youth of lower socioeconomic status and/or racial and ethnic minority youth [139]. Although there are established measures of diabetes distress, including the Problem Areas in Diabetes scale [140] and the Diabetes Distress Scale [141], these emotional issues are frequently not integrated into care.…”

Psychosocial Impact of the COVID-19 Pandemic in Racially/Ethnically Diverse Youth With Diabetes

“…Changes in income during the COVID-19 pandemic were associated, in at least one study, with decreased parenting quality, increased parental depression, and child internalizing and externalizing disorders ( Feinberg et al, 2022 ). Prior to the COVID-19 pandemic, numerous studies highlighted the impact of socioeconomic status on youth diabetes management and resulting glycemic health ( Drew et al., 2011 ; Fegan-Bohm et al, 2020 ; Liese et al, 2022 ; Sutherland et al, 2018 ). Future research examining glycemic trajectories for youth during the COVID-19 pandemic should carefully assess the role of employment, income, and barriers to accessing care on diabetes management and outcomes.…”

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

“…As the attention needed to attain optimal glucose control is a 24/7 effort, patients and their family often develop “diabetes distress” and burnout from the continuous daily struggle to manage the disease. 35-37 The currently recommended HbA1c goal may be beyond the ability of most patients/families to achieve with available management techniques. 33,34,38 In particular, pediatric NHB patients have HbA1c levels persistently higher than those of NHW or Hispanic ethnicity when matched for type of insulin delivery used and age.…”

“…5,62,63 This may contribute to NWB patients and their families having higher level of diabetes distress and associated higher HbA1c. 37…”