Conway Rebecca Baqiyyah, Gerard Gonzalez Andrea, Shah Viral N, Geno Rasmussen Cristy, Akturk Halis Kaan, Pyle Laura, Forlenza Gregory, Alonso Guy Todd, Snell-Bergeon Janet
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Diabetes Metab Syndr Obes. 2023 Aug 2;16:2295-2310. doi: 10.2147/DMSO.S416192. eCollection 2023.
Poorer glycemic control and higher diabetic ketoacidosis (DKA) rates are seen in racial/ethnic minorities with type 1 diabetes (T1D). Use of diabetes technologies such as continuous glucose monitors (CGM), continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems has been shown to improve glycemic control and reduce DKA risk. We examined race/ethnicity differences in diabetes technology use and their relationship with HbA1c and DKA.
Data from patients aged ≥12 years with T1D for ≥1 year, receiving care from a single diabetes center, were examined. Patients were classified as Non-Hispanic White (n=3945), Non-Hispanic Black (Black, n=161), Hispanic (n=719), and Multiracial/Other (n=714). General linear models and logistic regression were used.
Black (OR=0.22, 0.15-0.32) and Hispanic (OR=0.37, 0.30-0.45) patients were less likely to use diabetes technology. This disparity was greater in the pediatric population (p-interaction=0.06). Technology use associated with lower HbA1c in each race/ethnic group. Among technology users, AID use associated with lower HbA1c compared to CGM and/or CSII (HbA1c of 8.4% vs 9.2%, respectively), with the greatest difference observed for Black adult AID users. CSII use associated with a lower odds of DKA in the past year (OR=0.73, 0.54-0.99), a relationship that did not vary by race (p-interaction =0.69); this inverse association with DKA was not observed for CGM or AID.
Disparities in diabetes technology use, DKA, and glycemic control were apparent among Black and Hispanic patients with T1D. Differences in technology use ameliorated but did not fully account for disparities in HbA1c or DKA.
1型糖尿病（T1D）患者中，少数族裔的血糖控制较差，糖尿病酮症酸中毒（DKA）发生率较高。连续血糖监测仪（CGM）、持续皮下胰岛素输注（CSII）和自动胰岛素给药（AID）系统等糖尿病技术已被证明可改善血糖控制并降低DKA风险。我们研究了糖尿病技术使用方面的种族/民族差异及其与糖化血红蛋白（HbA1c）和DKA的关系。
对来自单一糖尿病中心、年龄≥12岁且患T1D≥1年的患者数据进行分析。患者分为非西班牙裔白人（n = 3945）、非西班牙裔黑人（黑人，n = 161）、西班牙裔（n = 719）和多种族/其他（n = 714）。使用一般线性模型和逻辑回归分析。
黑人（优势比[OR]=0.22，0.15 - 0.32）和西班牙裔患者（OR = 0.37，0.30 - 0.45）使用糖尿病技术的可能性较小。这种差异在儿科人群中更大（交互作用P值 = 0.06）。在每个种族/民族群体中，技术使用与较低的HbA1c相关。在技术使用者中，与CGM和/或CSII相比，使用AID与较低的HbA1c相关（HbA1c分别为8.4%和9.2%），黑人成年AID使用者的差异最大。过去一年中，使用CSII与较低的DKA几率相关（OR = 0.73，0.54 - 0.99），这种关系在不同种族间无差异（交互作用P值 = 0.69）；CGM或AID与DKA无这种负相关关系。
T1D黑人与西班牙裔患者在糖尿病技术使用、DKA和血糖控制方面存在明显差异。技术使用差异改善了但未完全解释HbA1c或DKA的差异。
