Association of Race and Ethnicity With Glycemic Control and Hemoglobin A1c Levels in Youth With Type 1 Diabetes

• Published in: JAMA network open Vol. 1; no. 5; p. e181851
• Main Authors: Kahkoska, Anna R, Shay, Christina M, Crandell, Jamie, Dabelea, Dana, Imperatore, Giuseppina, Lawrence, Jean M, Liese, Angela D, Pihoker, Cate, Reboussin, Beth A, Agarwal, Shivani, Tooze, Janet A, Wagenknecht, Lynne E, Zhong, Victor W, Mayer-Davis, Elizabeth J
• Format: Journal Article
• Language: English
• Published: Chicago American Medical Association 07.09.2018
• Subjects: Diabetes; Diabetes and Endocrinology; Ethnicity; Hemoglobin; Hispanic people; Online Only; Original Investigation; Race
• ISSN: 2574-3805
• DOI: 10.1001/jamanetworkopen.2018.1851

Importance Health disparities in the clinical presentation and outcomes among youth with type 1 diabetes exist. Long-term glycemic control patterns in racially/ethnically diverse youth are not well described. Objectives To model common trajectories of hemoglobin A1c(HbA1c) among youth with type 1 diabetes and test how trajectory group membership varies by race/ethnicity. Design, Setting, and Participants Longitudinal cohort study conducted in 5 US locations. The analysis included data from 1313 youths (aged <20 years) newly diagnosed in 2002 through 2005 with type 1 diabetes in the SEARCH for Diabetes in Youth study (mean [SD] age at diabetes onset, 8.9 [4.2] years) who had 3 or more HbA1cstudy measures during 6.1 to 13.3 years of follow-up. Data were analyzed in 2017. Exposures Self-reported race/ethnicity. Main Outcomes and Measures Hemoglobin A1ctrajectories identified through group-based trajectory modeling over a mean (SD) of 9.0 (1.4) years of diabetes duration. Multinomial models studied the association of race/ethnicity with HbA1ctrajectory group membership, adjusting for demographic characteristics, clinical factors, and socioeconomic position. Results The final study sample of 1313 patients was 49.3% female (647 patients) with mean (SD) age 9.7 (4.3) years and mean (SD) disease duration of 9.2 (6.3) months at baseline. The racial/ethnic composition was 77.0% non-Hispanic white (1011 patients), 10.7% Hispanic (140 patients), 9.8% non-Hispanic black (128 patients), and 2.6% other race/ethnicity (34 patients). Three HbA1ctrajectories were identified: group 1, low baseline and mild increases (50.7% [666 patients]); group 2, moderate baseline and moderate increases (41.7% [548 patients]); and group 3, moderate baseline and major increases (7.5% [99 patients]). Group 3 was composed of 47.5% nonwhite youths (47 patients). Non-Hispanic black youth had 7.98 higher unadjusted odds (95% CI, 4.42-14.38) than non-Hispanic white youth of being in the highest HbA1ctrajectory group relative to the lowest HbA1ctrajectory group; the association remained significant after full adjustment (adjusted odds ratio of non-Hispanic black race in group 3 vs group 1, 4.54; 95% CI, 2.08-9.89). Hispanic youth had 3.29 higher unadjusted odds (95% CI, 1.78-6.08) than non-Hispanic white youth of being in the highest HbA1ctrajectory group relative to the lowest HbA1ctrajectory group; the association remained significant after adjustment (adjusted odds ratio of Hispanic ethnicity in group 3 vs group 1, 2.24; 95% CI, 1.02-4.92). In stratified analyses, the adjusted odds of nonwhite membership in the highest HbA1ctrajectory remained significant among male patients and youth diagnosed at age 9 years or younger, but not female patients and youth who were older than 9 years when they were diagnosed (Pfor interaction = .04 [sex] and .02 [age at diagnosis]). Conclusions and Relevance There are racial/ethnic differences in long-term glycemic control among youth with type 1 diabetes, particularly among nonwhite male patients and nonwhite youth diagnosed earlier in life.