Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA.
Division of Endocrinology, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA.
J Diabetes Sci Technol. 2022 Jul;16(4):929-933. doi: 10.1177/19322968221082646. Epub 2022 Jun 5.
Type-1 diabetes (T1D) management and glycemic control the year after diagnosis affects the long-term trajectory of T1D. Disparities in hemoglobin A1c (HbA1c) based on race, ethnicity, and socioeconomic status (SES) have been well-documented; however, there has been limited investigation into the timeline with which these disparities develop. This study aims to assess differences in HbA1c by race/ethnicity and SES among youth with T1D over 1 year post diagnosis.
HbA1c at onset, and 3, 6, 9, and 12 months following diagnosis was collected from youth with T1D between 2016 and 2020. Mixed-effect models examined associations of HbA1c over time with race/ethnicity and SES.
Of 758 patients, 71% identified as white. Mean (± SD) HbA1c was 11.4% ± 2.2% at diagnosis and 7.3% ± 1.2%, 7.3% ± 1.3%, 7.7% ± 1.4%, and 7.9% ± 1.4% at 3, 6, 9, and 12 months, respectively. HbA1c trajectories over time differed significantly by race (adjusting for sex and zip-code education and poverty levels) with Hispanic and black youth demonstrating higher HbA1c 1 year after diagnosis (8.7% vs 7.7%, < .001) than white youth.
These data revealed that youth did not meet glycemic targets at 1 year post diagnosis and that racial/ethnic minority youth had higher HbA1c 1 year post diagnosis, highlighting the need to optimize glycemic control and mitigate disparities early. Understanding the time course of these outcomes helps to inform the need for early interventions, particularly in disadvantaged patient populations, to lay the groundwork for improved control. Further research must also be done to better understand overlapping axes of disparities including race, ethnicity, and SES.
1 型糖尿病（T1D）的管理和诊断后血糖控制会影响 T1D 的长期发展轨迹。基于种族、民族和社会经济地位（SES）的血红蛋白 A1c（HbA1c）差异已有充分记录；然而，对于这些差异发展的时间轨迹，研究有限。本研究旨在评估诊断后 1 年内 T1D 青少年的 HbA1c 基于种族/民族和 SES 的差异。
从 2016 年至 2020 年期间患有 T1D 的青少年中收集了发病时以及诊断后 3、6、9 和 12 个月的 HbA1c。混合效应模型检查了 HbA1c 随时间的变化与种族/民族和 SES 的关联。
在 758 名患者中，71%的患者为白人。诊断时平均（±SD）HbA1c 为 11.4%±2.2%，3、6、9 和 12 个月时分别为 7.3%±1.2%、7.3%±1.3%、7.7%±1.4%和 7.9%±1.4%。HbA1c 随时间的变化轨迹在种族上差异显著（调整性别和邮政编码的教育和贫困水平），西班牙裔和黑人青少年在诊断后 1 年的 HbA1c 更高（8.7%比 7.7%，<.001）比白人青少年。
这些数据表明，青少年在诊断后 1 年未达到血糖目标，且少数民族青少年在诊断后 1 年的 HbA1c 更高，这突显了优化血糖控制和尽早减少差异的必要性。了解这些结果的时间过程有助于了解早期干预的必要性，特别是在弱势群体中，为改善控制奠定基础。还需要进一步研究以更好地了解包括种族、民族和 SES 在内的差异的重叠轴。
