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ARS Home » Plains Area » Houston, Texas » Children's Nutrition Research Center » Research » Publications at this Location » Publication #365518
Title: Racial/ethnic minority youth with recent onset type 1 diabetes have poor prognostic factors

Author
item REDONDO, MARIA - Baylor College Of Medicine
item LIBMAN, I - University Of Pittsburgh
item CHENG, P - Jaeb Center For Health Research
item KOLLMAN, C - Jaeb Center For Health Research
item TOSUR, MUSTAFA - Baylor College Of Medicine
item GAL, R - Jaeb Center For Health Research
item BACHA, FIDA - Children'S Nutrition Research Center (CNRC)
item KLINGENSMITH, G - University Of Colorado
item CLEMENTS, M - University Of Missouri

Submitted to: Diabetes Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/6/2018
Publication Date: 5/1/2018
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(5):1017-1024. https://doi.org/10.2337/dc17-2335.
DOI: https://doi.org/10.2337/dc17-2335

Interpretive Summary: Some racial differences exist in the outcomes of diabetes in adults. In this study, we aimed to determine if there are race/ethnicity differences in youth with type 1 diabetes at diagnosis and during the first 3 years post-diagnosis, in factors known to influence long-term health outcomes. We analyzed data on 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, followed for up to 3.6 years after their diagnosis. We found that AA youth, compared with NHW, at diagnosis, were heavier and had higher frequency of presentation in diabetic ketoacidosis (a severe complication of diabetes). These differences were largely explained by socioeconomic factors. During the first 3 years after diagnosis, AA children were more likely to have elevated blood pressure, hypoglycemia (low blood sugar) events; and worse glucose control, and require higher insulin doses. They were also less likely to experience a partial improvement of their diabetes within the first year after diagnosis. 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 elevated lipids and required higher insulin doses. We conclude that youth of minority race/ethnicity have increased risk factors of adverse outcomes of type 1 diabetes at diagnosis and 3 years post-diagnosis, possibly contributing to higher risk of long-term diabetes complications compared with NHWs.

Technical Abstract: Our objective was to compare races/ethnicities for characteristics, at type 1 diabetes diagnosis and during the first 3 years postdiagnosis, 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 the partial remission period. Hispanics, compared with NHWs, had higher BMI% at diagnosis and over the three subsequent years. During the 3 years postdiagnosis, 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 postdiagnosis, possibly contributing to higher risk of long-term diabetes complications compared with NHWs.