Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA, USA; University of Pennsylvania School of Nursing, PA, USA; Perelman School of Medicine, University of Pennsylvania, PA, USA.
Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, PA, USA.
J Pediatr Nurs. 2020 Nov-Dec;55:110-115. doi: 10.1016/j.pedn.2020.08.007. Epub 2020 Sep 1.
Racial disparities have been shown in outcomes and treatment of children with type 1 diabetes (T1D). The purpose of this study was to examine temporal trends in insulin pump use among non-Hispanic white (NHW), non-Hispanic black (NHB) and Hispanic children attending a large urban diabetes center. . This study was a retrospective chart review of insulin pump usage by race (NHW/ NHB) in 2005, and race/ethnicity (NHW/NHB/Hispanic) in 2011-2019. Demographic data (age, sex, diabetes duration, SES) and most recent hemoglobin A1c were also abstracted in 2011-2019.
In 2005, NHW children were twice as likely to use an insulin pump as NHB children. From 2011 to 2019, the odds ratio increased to 2.5 for NHW compared to NHB children. The odds of Hispanic children using insulin pumps were also higher than NHB. Insurance status (government versus private), a surrogate for SES, had very little influence on these trends, with NHW children consistently more likely than NHB children to be treated with insulin pumps in 2011, 2013, 2017, 2019 (p < 0.001).
We have demonstrated that racial disparities in insulin pump use have persisted over the past 15 years, and are not determined by SES. This inequity in diabetes treatment may be playing a role in the poorer glycemic control and higher rates of diabetes complications in NHB children.
Healthcare providers should be cognizant of racial and ethnic disparities in the treatment of children with T1D. Standardized treatment protocols may reduce unconscious bias in prescribing.
种族差异在儿童 1 型糖尿病（T1D）的治疗结果中已经显现出来。本研究旨在检验在一家大型城市糖尿病中心就诊的非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）和西班牙裔儿童中，使用胰岛素泵的时间趋势。这项研究是对 2005 年按种族（NHW/NHB）使用胰岛素泵和 2011-2019 年按种族/族裔（NHW/NHB/西班牙裔）使用胰岛素泵的情况进行的回顾性图表审查。还在 2011-2019 年期间提取了人口统计学数据（年龄、性别、糖尿病持续时间、SES）和最近的糖化血红蛋白。
2005 年，NHW 儿童使用胰岛素泵的可能性是 NHB 儿童的两倍。从 2011 年到 2019 年，与 NHB 儿童相比，NHW 儿童使用胰岛素泵的比值比增加到 2.5。西班牙裔儿童使用胰岛素泵的可能性也高于 NHB。保险状况（政府与私人），SES 的替代指标，对这些趋势几乎没有影响，在 2011 年、2013 年、2017 年和 2019 年，NHW 儿童比 NHB 儿童更有可能接受胰岛素泵治疗（p<0.001）。
我们已经证明，在过去 15 年中，胰岛素泵使用方面的种族差异持续存在，并且不受 SES 影响。这种糖尿病治疗的不平等可能在 NHB 儿童中较差的血糖控制和更高的糖尿病并发症发生率中发挥作用。
医疗保健提供者应该意识到治疗 T1D 儿童方面的种族和族裔差异。标准化的治疗方案可能会减少处方中的无意识偏见。
