Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

Abstract

Aims/hypothesis This study was performed to evaluate the influence of ethnicity and socioeconomic status (SES) on metabolic control in a population-based cohort of children with type 1 diabetes mellitus, and to evaluate whether any relationship between ethnicity and HbA 1c is mediated by SES. Methods We performed a retrospective review of all patients under age 16 years with type 1 diabetes (n=555) from 1995 to 2005 in the greater Auckland region, New Zealand. Diabetes care variables and HbA 1c values were collected prospectively, during clinic visits. Results The mean population HbA 1c was 8.3±1.3%. Maori and Pacific patients had poorer metabolic control than their European counterparts (9.1% and 9.3% vs 8.1%, p<0.001) and higher rates of moderate to severe hypoglycaemia (31.1 and 24.8 vs 14.9 events/100 patient-years, p=0.03). In multiple linear regression analysis, both ethnicity and SES were independently associated with HbA 1c (p<0.001). Other factors associated with higher HbA 1c level were longer duration of diabetes, higher insulin dose, lower BMI z score and less frequent blood glucose monitoring (p<0.001).Conclusions/interpretation Both ethnicity and SES independently influenced metabolic control in a large, unselected population of children with type 1 diabetes. Irrespective of SES, Maori and Pacific youth with type 1 diabetes were at greater risk of both moderate to severe hypoglycaemia and long-term complications associated with poor metabolic control.

Deprivation and ethnicity impact on diabetes control and use of treatment regimen

“…These findings accord with other observations in diabetes in both paediatric and adult populations in other parts of the world [5][6][7]13] and within similar paediatric populations in the UK [8]. Access to more intensive insulin regimens (multiple daily injections) appeared better in the African population, but uptake of insulin pump therapy was less than other groups.…”

“…The mean age was 10.6 years (range [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], with an average duration of diabetes of 4.5 years. At each quarterly clinic visit, HbA 1c was measured, using the Siemens DCA1000 (Bayer) near-patient testing system (Siemens Healthcare Diagnostics Inc., Deerfield, IL, USA).…”

Natural course of untreated microalbuminuria in children and adolescents with type 1 diabetes and the importance of diabetes duration and immigrant status: longitudinal analysis from the prospective nationwide German and Austrian diabetes survey DPV

“…The focus on the natural course of microalbuminuria, the large number of children in the survey in a real-world setting, and the very homogeneous cohort of children regarding age and diabetes duration are major strengths of the present survey. To date, little is known about the development of diabetic complications and comorbidities in type 1 diabetes in different population groups (21,22,23,24). Differences in health status in immigrant and non-immigrant families may explain Figure 1 The rates (% and absolute numbers) of the 683 children with type 1 diabetes with normoalbuminuria, intermittent and persistent microalbuminuria at baseline, and the progression and regression of microalbuminuria after a follow-up of 5 years are depicted.…”

“…Principally, there is growing awareness of differences in health status between various population groups (24,25,26,27,28,29,30). The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) conducted from 2003 to 2006 showed that general state of health is estimated to be lower in children with immigrant status compared with those with non-immigrant status (29).…”

“…However, further analysis showed that BMI SDS was not a significant risk factor for the development or progression of microalbuminuria. Disparities in lifestyle and nutrition habits may account for different health status in immigrant and non-immigrant families (24,30). The KiGGS study reported considerable differences in food intake and dietary habits in children and adolescents with immigrant status compared with those with non-immigrant status (30).…”