title: Racial-ethnic disparities in management and outcomes among children with type 1 diabetes.
abstract: OBJECTIVE
  Previous research has documented racial/ethnic disparities in diabetes treatments and outcomes. It remains controversial whether these disparities result from differences in socioeconomic status (SES) or other factors. We examined racial/ethnic disparities in therapeutic modalities and diabetes outcomes among the large number of pediatric participants in the T1D Exchange Clinic Registry.
  
  
  METHODS
  The cohort included 10 704 participants aged <18 years with type 1 diabetes for ≥1 year (48% female; mean age: 11.9 ± 3.6 years; diabetes duration: 5.2 ± 3.5 years). Diabetes management and clinical outcomes were compared among 8841 non-Hispanic white (white) (83%), 697 non-Hispanic black (black) (7%), and 1166 Hispanic (11%) participants. The population included 214 high-income black and Hispanic families.
  
  
  RESULTS
  Insulin pump use was higher in white participants than in black or Hispanic participants (61% vs 26% and 39%, respectively) after adjusting for gender, age, diabetes duration, and SES (P < .001). Mean hemoglobin A1c was higher (adjusted P < .001) in black participants than in white or Hispanic participants (9.6%, 8.4%, and 8.7%). More black participants experienced diabetic ketoacidosis and severe hypoglycemic events in the previous year than white or Hispanic participants (both, P < .001). There were no significant differences in hemoglobin A1c, diabetic ketoacidosis, or severe hypoglycemia between white and Hispanic participants after adjustment for SES.
  
  
  CONCLUSIONS
  Even after SES adjustment, marked disparities in insulin treatment method and treatment outcomes existed between black versus Hispanic and white children within this large pediatric cohort. Barriers to insulin pump use and optimal glycemic control beyond SES should be explored in all ethnic groups.
authors: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors: Steven M
authors: SM
authors: Willi
authors: Jaeb Center for Health Research, Tampa, Florida; t1dstats@jaeb.org.
authors: Kellee M
authors: KM
authors: Miller
authors: Indiana University School of Medicine, Indianapolis, Indiana;
authors: Linda A
authors: LA
authors: DiMeglio
authors: Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Colorado;
authors: Georgeanna J
authors: GJ
authors: Klingensmith
authors: Vanderbilt University Medical Center, Nashville, Tennessee;
authors: Jill H
authors: JH
authors: Simmons
authors: Yale University, New Haven, Connecticut;
authors: William V
authors: WV
authors: Tamborlane
authors: University of Colorado Denver and Children's Hospital Colorado, Denver, Colorado;
authors: Kristen J
authors: KJ
authors: Nadeau
authors: Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota; and.
authors: Julie M
authors: JM
authors: Kittelsrud
authors: Rand Corporation, Santa Monica, California.
authors: Peter
authors: P
authors: Huckfeldt
authors: Jaeb Center for Health Research, Tampa, Florida;
authors: Roy W
authors: RW
authors: Beck
authors: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors: Terri H
authors: TH
authors: Lipman
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000208:ethnology*; D019468:Disease Management; D005006:Ethnicity; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: diabetes management; ethnicity; glycemic control; race; type 1 diabetes