Racial differences in neighborhood disadvantage, inflammation and metabolic control in black and white pediatric type 1 diabetes patients

• Published in: Pediatric diabetes Vol. 18; no. 2; pp. 120 - 127
• Main Authors: Coulon, Sara J., Velasco‐Gonzalez, Cruz, Scribner, Richard, Park, Chi L., Gomez, Ricardo, Vargas, Alfonso, Stender, Sarah, Zabaleta, Jovanny, Clesi, Patrice, Chalew, Stuart A., Hempe, James M.
• Format: Journal Article
• Language: English
• Published: Former Munksgaard John Wiley & Sons A/S 01.03.2017; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Black or African American; Black People - statistics & numerical data; Blood glucose; Blood Glucose - metabolism; C-reactive protein; Census; Child; Child, Preschool; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - ethnology; Environmental effects; Female; Glucose; Glycated Hemoglobin - metabolism; Health Status Disparities; Hemoglobin; hemoglobin A1c; Humans; Inflammation; Inflammation - complications; Inflammation - ethnology; Male; Metabolism; Neighborhoods; New Orleans - epidemiology; Patients; Pediatrics; Race; racial bias; Racial differences; Racial Groups - statistics & numerical data; Residence Characteristics; Self Care - statistics & numerical data; Socioeconomic Factors; type 1 diabetes mellitus; Vulnerable Populations - ethnology; Vulnerable Populations - statistics & numerical data; White People - statistics & numerical data; Young Adult; New Orleans; socioeconomic factors; type 1 diabetes mellitus; hemoglobin A1c; inflammation; racial bias
• ISSN: 1399-543X; 1399-5448; 1399-5448
• DOI: 10.1111/pedi.12361

Background Racial variation in the relationship between blood glucose and hemoglobin A1c (HbA1c) complicates diabetes diagnosis and management in racially mixed populations. Understanding why HbA1c is persistently higher in blacks than whites could help reduce racial disparity in diabetes outcomes. Objective Test the hypothesis that neighborhood disadvantage is associated with inflammation and poor metabolic control in a racially mixed population of pediatric type 1 diabetes patients. Methods Patients (n = 86, 53 white, 33 black) were recruited from diabetes clinics. Self‐monitored mean blood glucose (MBG) was downloaded from patient glucose meters. Blood was collected for analysis of HbA1c and C‐reactive protein (CRP). Patient addresses and census data were used to calculate a concentrated disadvantage index (CDI). High CDI reflects characteristics of disadvantaged neighborhoods. Results HbA1c and MBG were higher (p < 0.0001) in blacks [10.4% (90.3 mmol/mol), 255 mg/dL] than whites [8.9% (73.9 mmol/mol), 198 mg/dL). CDI was higher in blacks (p < 0.0001) and positively correlated with HbA1c (r = 0.40, p = 0.0002) and MBG (r = 0.35, p = 0.0011) unless controlled for race. CDI was positively associated with CRP by linear regression within racial groups. CRP was not different between racial groups, and was not correlated with MBG, but was positively correlated with HbA1c when controlled for race (p = 0.04). Conclusions Neighborhood disadvantage was associated with inflammation and poor metabolic control in pediatric type 1 diabetes patients. Marked racial differences in potential confounding factors precluded differentiation between genetic and environmental effects. Future studies should recruit patients matched for neighborhood characteristics and treatment regimen to more comprehensively assess racial variation in HbA1c.