Racial/ethnic minority youth with recent-onset type 1 diabetes have poor prognostic factors

Authors: REDONDO, MARIA - Children'S Nutrition Research Center (CNRC); LIBMAN, INGRID - University Of Pittsburgh Medical Center; CHENG, PEIYAO - Jaeb Center For Health Research; KOLLMAN, CRAIG - Jaeb Center For Health Research; TOSUR, MUSTAFA - Children'S Nutrition Research Center (CNRC); GAL, ROBIN - Jaeb Center For Health Research; BACHA, FIDA - Children'S Nutrition Research Center (CNRC); KLINGENSMITH, GEORGEANNA - University Of Colorado; CLEMENTS, MARK - University Of Missouri

Submitted to: Diabetes Care
Publication Type: Other
Publication Acceptance Date: 7/1/2018
Publication Date: 7/1/2018
Citation: Redondo, M.J., Libman, I., Cheng, P., Kollman, C., Tosur, M., Gal, R.L., Bacha, F., Klingensmith, G.J., Clements, M. 2018. Racial/ethnic minority youth with recent-onset type 1 diabetes have poor prognostic factors. Diabetes Care. 41(7):e125-e126. https://doi.org/10.2337/dci18-0017.
DOI: https://doi.org/10.2337/dci18-0017

Interpretive Summary:

Technical Abstract: To compare races/ethnicities for characteristics, at type 1 diabetes diagnosis and during the first 3 years post diagnosis, known to influence long-term health outcomes. We analyzed 927 Pediatric Diabetes Consortium (PDC) participants <19 years old (631 non-Hispanic white [NHW], 216 Hispanic, and 80 African American [AA]) diagnosed with type 1 diabetes and followed for a median of 3.0 years (interquartile range 2.2–3.6). Demographic and clinical data were collected from medical records and patient/parent interviews. Partial remission period or “honeymoon” was defined as insulin dose–adjusted hemoglobin A1C (IDAA1c) = 9.0%. We used logistic, linear, and multinomial regression models, as well as repeated measures logistic and linear regression models. Models were adjusted for known confounders. AA subjects, compared with NHW, at diagnosis, were in a higher age- and sex-adjusted BMI percentile (BMI %), had more advanced pubertal development, and had higher frequency of presentation in diabetic ketoacidosis, largely explained by socioeconomic factors. During the first 3 years, AA subjects were more likely to have hypertension and severe hypoglycemia events; had trajectories with higher hemoglobin A1C, BMI %, insulin doses, and IDAA1c; and were less likely to enter partial remission period. Hispanics, compared with NHWs, had higher BMI % at diagnosis and over the three subsequent years. During the 3 years post diagnosis, Hispanics had higher prevalence of dyslipidemia and maintained trajectories of higher insulin doses and IDAA1c. Youth of minority race/ethnicity have increased markers of poor prognosis of type 1 diabetes at diagnosis and 3 years post diagnosis, possibly contributing to higher risk of long-term diabetes complications compared with NHWs.