Abstract
Young adults (YA) with type 1 diabetes (T1D) are vulnerable to short and long-term complications as they incorporate disease self-management into the transition to adulthood. Relationships between race-ethnicity and socioeconomic status (SES) have not been examined in this population, despite poorer outcomes in minority and low SES subgroups. We administered a survey on demographics, clinical factors, self-management, and social determinants of health to non-Hispanic black (NHB), Hispanic, and non-Hispanic white (NHW) YA from 6 centers in the T1D Exchange. We compared survey responses and diabetes outcomes among the racial-ethnic groups using Fisher’s exact test or Wilcoxon rank-sum test, as appropriate. Participants (97 NHB, 103 Hispanic, 100 NHW) had a mean age of 21±2 years and T1D duration of 11±5 years. Low SES was more common in NHB and Hispanic vs. NHW YA (Medicaid 57% and 76% vs. 22%; high school education or less 66% and 70% vs. 24%, respectively; p<0.001). NHB and Hispanic YA had lower use of continuous glucose monitors (28% and 37%) and insulin pumps (18% and 39%) vs. NHW (71% and 72%) (p<0.001). Non-Hispanic black, but not Hispanic, YA had higher food insecurity, poorer self-management, greater diabetes-related distress, and more adverse childhood experiences than NHW (all p<0.001). NHB also had higher A1c levels (NHB 10.5%, Hispanic 8.6%, NHW 8.1%) and higher diabetes-specific health care utilization, with 46% of NHB having ≥1 hospital or ER admission in the past year vs. 17% and 12% in Hispanic and NHW (p<0.001 for NHB vs. NHW). Non-Hispanic black and Hispanic YA with T1D face similar economic disadvantages, yet NHB YA exhibit poorer glycemic control and higher acute healthcare utilization than Hispanic YA. NHB differed from Hispanic YA on self-management, psychosocial factors, and adverse childhood experiences. Factors contributing to these disparities (e.g., healthcare system interactions, cultural differences) should be explored to design effective interventions.
Disclosure
S. Agarwal: None. L. Kanapka: None. J. Raymond: Other Relationship; Self; Insulet Corporation. A.F. Walker: None. A. Gerard Gonzalez: None. D.F. Kruger: Advisory Panel; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Insulet Corporation. Consultant; Self; CeQur Corporation, Hygieia. Speaker's Bureau; Self; AstraZeneca, Dexcom, Inc., Eli Lilly and Company. Stock/Shareholder; Self; Dexcom, Inc. Other Relationship; Self; Novo Nordisk Inc. M.J. Redondo: None. M.R. Rickels: None. V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. A. Butler: None. V. Miller: None. R.L. Gal: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Roche Diagnostic USA. Research Support; Self; Jaeb Center for Health Research, National Institute of Allergy and Infectious Diseases, Sanofi-Aventis. Other Relationship; Self; National Institute of Diabetes and Digestive and Kidney Diseases. J.A. Long: None.
Funding
The Leona M. and Harry B. Helmsley Charitable Trust; National Institute of Diabetes and Digestive and Kidney Diseases