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. 2018 Dec;32(12):1085-1090.
doi: 10.1016/j.jdiacomp.2018.02.008. Epub 2018 Aug 10.

Hemoglobin A1c, frequency of glucose testing and social disadvantage: Metrics of racial health disparity in youth with type 1 diabetes

Stuart Chalew  1 , Ricardo Gomez  2 , Alfonso Vargas  2 , Jodi Kamps  3 , Brittney Jurgen  3 , Richard Scribner  4 , James Hempe  5
Affiliations

Hemoglobin A1c, frequency of glucose testing and social disadvantage: Metrics of racial health disparity in youth with type 1 diabetes

Stuart Chalew et al. J Diabetes Complications. 2018 Dec.

Abstract

Introduction: Black youth with type 1 diabetes (T1D) have higher HbA1c than whites. To understand HbA1c differences, we examined the relationship of psycho-social factors and glucose testing with HbA1c.

Methods: Glucose tests per day (BGs/d) and mean blood glucose (MBG) were calculated from meter data of youth self-identified as black (n = 33) or white (n = 53) with T1D. HbA1c, family income, insurance status, concentrated disadvantage (CDI), psychological depression (DSC), mother educational attainment (MEA), and insulin delivery method (IDM) data was were analyzed.

Results: Black patients had significantly higher HbA1c, MBG and disadvantage measures compared to whites. BGs/d correlated with HbA1c, MBG, age and CDI. Race (p < 0.0158), age (p < 0.0001) and IDM (p < 0.0036) accounted for 50% of the variability (R2 = 0.5, p < 0.0001) in BGs/d. Regardless of age, black patients had lower BGs/d than whites. MBG (p < 0.0001) and BGs/d (p < 0.0001) accounted for 61% of the variance in HbA1c (p < 0.0001).

Conclusions: BGs/d is easily assessed and closely associated with HbA1c racial disparity. BGs/d is intricately linked with greater social disadvantage. Innovative management approaches are needed to overcome obstacles to optimal outcomes.

Keywords: Children; Frequency of glucose testing; HbA1c; Home glucose monitoring; Racial disparity; Type 1 diabetes.

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