Racial disparities in treatment and outcomes of children with type 1 diabetes

Abstract

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.

Influence of social determinants of health barriers to family management of type 1 diabetes in Black single parent families: A mixed methods study

“…Racial disparities for Black youth in type 1 diabetes outcomes, management, and treatment have been increasing over the past several decades, [6][7][8] and are experienced disproportionately among Black youth from single parent homes, as compared to those from two parent homes. [9][10][11]13 Single-parent families have different experiences of parenting stress, responsibilities, and resources than do most twoparent families.…”

“…[4][5][6] Racial disparities in treatment, management and outcomes persist even after controlling for differences in parental income, education, and insurance. 7,8 When family structure (two-parent versus single parent) is considered, Black youth from single parent homes experience worsened diabetesrelated health outcomes such as, increased glucose levels, 9,10 greater difficulties maintaining complex treatment regimens, 11 less frequent blood glucose testing, 11 and decreased psychological adaptation to the disease, 12 as compared to White and Hispanic youth from single-parent homes, 9,11,13 or Black youth from two-parent homes. 5,9,13 Single parent households have differing levels of physical, economic and socio-emotional supports than two parent households, that may contribute to differences in pediatric chronic disease management.…”

“…Inflicting physical pain on their child during glucose testing and medication administration (i.e., parental stress related to diabetes care and managing child's pain items) was a significant source of emotional stress for parents, echoed in prior research. 27 However, significant racial disparities exist in the use of pain saving technologies, such as CGM and insulin pumps, 8 among Black families with little clarity as to why.…”

Impact of COVID-19 on Health Economics and Technology of Diabetes Care: Use Cases of Real-Time Continuous Glucose Monitoring to Transform Health Care During a Global Pandemic

“…For example, a recently published article by Lipman et al analyzed the accessibility of new technologies including continuous glucose monitoring (CGM) and pumps by the pediatric type 1 diabetes (T1D) population, finding that racial disparities in technology use and diabetes outcomes (higher hemoglobin A1C [HbA1c], hospitalizations, emergency department visits) persist in children with T1D, regardless of insurance status. 11 The pandemic has exacerbated these inequities, not only by disproportionately affecting certain populations to the virus itself, but also through the second- and third-order effects of public policies and nonpharmaceutical interventions. For example, social distancing, isolation, travel restrictions, and school closures have impacted household incomes and led to job losses across various industries, especially hospitality, tourism, and manufacturing.…”

Widening health inequalities related to type 1 diabetes care in children and young people in the UK: A time to act now

“…While cultural factors such as differences in the perception of what constitutes good management may be contributary, the authors noted that implicit racial and ethnic bias among healthcare professionals may also contribute to disparities in the treatment and outcomes of minority patients. 6 In a study by Farrington et al, clinicians were found to exhibit a range of opinions and attitudes towards eligibility to closed-loop technology access for type 1 diabetes. 7 Technology adoption and equitable uptake should be dependent on robust implementation pathways; otherwise, there is a risk of clinicians drawing on informal criteria to limit or expand access, as with current insulin pumps and CGM technologies.…”