Abstract
Minority and socioeconomic disparity in glycemic control exists in young adults (YA) with type 1 diabetes (T1D). The contribution of social determinants of health versus diabetes-specific clinical care factors to these disparities remains unclear. We administered a survey on demographics, clinical factors, self-management, and social determinants to non-Hispanic black (NHB), Hispanic, and non-Hispanic white (NHW) YA from 6 centers in the T1D Exchange. We examined bivariate associations of variables with A1c and added significant factors to a linear regression model in sequential groups. A1c disparity was the outcome. We adjusted models for race-ethnicity, age, gender, and T1D duration. We recruited 300 YA (97 NHB, 103 Hispanic, 100 NHW) with mean age of 21±2 years and T1D duration of 11±5 years. NHB but not Hispanic YA had higher A1c vs. NHW (p<0.001) (NHB 10.5%, Hispanic 8.6%, NHW 8.1%). Only lower education attainment, lower pump use, receiving care in an adult system, and worse self-management were associated with A1c in the final model (Table 1), explaining 31% of the variance in A1c. Few social determinants were associated with A1c once examined with diabetes care factors. While social factors should be considered in the care of vulnerable YA, clinicians should continue to emphasize diabetes self-management and technology treatment options.
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. A. Verdejo: 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