Health Disparities Likely Emerge Early in the Course of Type-1 Diabetes in Youth

Abstract

Background: 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. Methods: 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. Results: 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%, p < .001) than white youth. Conclusions: 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.