Division of Pediatric Endocrinology, Stanford University, Stanford, CA
University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany.
Diabetes Care. 2021 Jan;44(1):133-140. doi: 10.2337/dc20-0257. Epub 2020 Sep 16.
As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A (HbA). We hypothesized that an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA disparities.
Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, U.S., = 16,457) and Diabetes Prospective Follow-up (DPV, Germany, = 39,836) registries were categorized into lowest (Q1) to highest (Q5) SES quintiles. Multiple regression analyses compared the relationship of SES quintiles with diabetes technology use and HbA from 2010-2012 to 2016-2018.
HbA was higher in participants with lower SES (in 2010-2012 and 2016-2018, respectively: 8.0% and 7.8% in Q1 and 7.6% and 7.5% in Q5 for DPV; 9.0% and 9.3% in Q1 and 7.8% and 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA did not change between the two time periods, whereas for T1DX, disparities in HbA by SES increased significantly ( < 0.001). After adjusting for technology use, results for DPV did not change, whereas the increase in T1DX was no longer significant.
Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA is highest in those of the lowest SES quintile in the T1DX, and this difference for HbA broadened in the past decade. Associations of SES with technology use and HbA were weaker in the DPV registry.
随着全球范围内青少年对糖尿病技术的使用不断增加，获取途径的不平等可能会加剧血红蛋白 A（HbA）方面的差异。我们假设，社会经济地位（SES）方面糖尿病技术使用差距的扩大将与 HbA 差异的扩大有关。
在 1 型糖尿病交换（T1DX，美国，n = 16457）和糖尿病前瞻性随访（DPV，德国，n = 39836）登记处中，年龄<18 岁且糖尿病病程≥1 年的参与者被分为 SES 最低（Q1）到最高（Q5）五分位数。多元回归分析比较了 SES 五分位数与 2010-2012 年至 2016-2018 年期间糖尿病技术的使用和 HbA 的关系。
SES 较低的参与者 HbA 较高（2010-2012 年和 2016-2018 年，分别为 DPV 的 Q1 和 Q5：8.0%和 7.8%；7.6%和 7.5%；T1DX 的 Q1 和 Q5：9.0%和 9.3%；7.8%和 8.0%）。对于 DPV，SES 与 HbA 之间的关系在两个时间段内没有变化，而对于 T1DX，SES 导致的 HbA 差异显著增加（<0.001）。在调整了技术使用后，DPV 的结果没有改变，而 T1DX 的 HbA 差异增加不再显著。
尽管不能得出因果结论，但在 T1DX 中，SES 最低五分位数的患者的糖尿病技术使用率最低，HbA 最高，而在过去十年中，这种 HbA 差异有所扩大。在 DPV 登记处中，SES 与技术使用和 HbA 的关联较弱。
