Predictors of glycemic control in children with Type 1 diabetes

Chalew, Stuart A.; Gómez, Ricardo; Butler, Ashley M.; Hempe, James M.; Compton, Terry; Mercante, Donald E.; Rao, Jayashree K.; Vargas, Alfonso

doi:10.1016/s1056-8727(00)00072-6

Cited by 55 publications

(36 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2 Previous studies of children with type 1 diabetes have found that nonHispanic black (black) children tend to have poorer glycemic control than non-Hispanic white (white) children as evidenced by higher hemoglobin A1c (HbA1c) values; many studies suggest that glycemic control in Hispanic children is intermediate (ie, between that of white and black subjects). 1,[3][4][5][6][7][8][9][10] Poor glycemic control has been associated with a ninefold higher mortality rate among black subjects compared with white subjects with type 1 diabetes aged ,25 years, primarily due to an increased incidence of diabetic ketoacidosis (DKA) in black subjects. 11 Racial/ethnic disparities have also been reported in treatment regimens used in pediatric patients with type 1 diabetes.…”

Section: What This Study Addsmentioning

confidence: 99%

Racial-Ethnic Disparities in Management and Outcomes Among Children With Type 1 Diabetes

et al. 2015

View full text Add to dashboard Cite

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.

show abstract

Section: What This Study Addsmentioning

confidence: 99%

Racial-Ethnic Disparities in Management and Outcomes Among Children With Type 1 Diabetes

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Racial disparities exist in the treatment and outcomes of children with type 1 diabetes. It has been shown that black children with type 1 diabetes have poorer metabolic control (21)(22)(23)(24). A ninefold increased risk of death was demonstrated for young African Americans with diabetes in Chicago, compared with non-Hispanic white patients with type 1 diabetes over an 8-year period (25).…”

Section: Conclusion -In 1990mentioning

confidence: 99%

Incidence of Type 1 Diabetes in Philadelphia Is Higher in Black Than White Children From 1995 to 1999

et al. 2006

View full text Add to dashboard Cite

OBJECTIVE—To determine the epidemiology of type 1 diabetes in children in Philadelphia, Pennsylvania, from 1995 through 1999 and compare these data with previous cohorts. RESEARCH DESIGN AND METHODS—This is a report of a retrospective population-based registry maintained since 1985. Hospital records meeting the following criteria were reviewed: newly diagnosed type 1 diabetes, age 0–14 years, residing in Philadelphia at the time of diagnosis, and diagnosed from 1 January 1995 to 31 December 1999. The secondary source of validation was the School District of Philadelphia. Incidence rates by race and age were compared with 1985–1989 and 1990–1994 cohorts. RESULTS—A total of 234 case subjects were identified, and the registry was determined to be 96% complete. The overall age-adjusted incidence rate in Philadelphia was 14.8 per 100,000/year. Incidence rates in Hispanic children (15.5 per 100,000/year) and white children (12.8 per 100,000/year) have been relatively stable over 15 years. The incidence in black children (15.2 per 100,000/year), however, has increased dramatically, rising 64% in children 5–9 years of age (14.9 per 100,000/year) and 37% in the 10- to 14-year age-group (26.9 per 100,000/year). CONCLUSIONS—The overall incidence of type 1 diabetes in Philadelphia is increasing and is similar to other U.S. registries. These are the first data reporting a higher incidence in black children in a registry of children 0–14 years of age. The etiology of the marked increase in incidence in the black population is unknown and underscores the need to establish type 1 diabetes as a reportable disease, so that environmental risk factors may be thoroughly investigated.

show abstract

“…Cross-sectional studies typically show that children of ethnic minorities have higher HbA 1c levels [13][14][15][16]. However, it remains unclear whether this poorer metabolic control is independent of SES, and many of the studies examined selected cohorts that may not be representative of the general population [2,[17][18][19].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2008

View full text Add to dashboard Cite

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.

show abstract

Predictors of glycemic control in children with Type 1 diabetes

Cited by 55 publications

References 16 publications

Racial-Ethnic Disparities in Management and Outcomes Among Children With Type 1 Diabetes

Racial-Ethnic Disparities in Management and Outcomes Among Children With Type 1 Diabetes

Incidence of Type 1 Diabetes in Philadelphia Is Higher in Black Than White Children From 1995 to 1999

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

Contact Info

Product

Resources

About