A Decade of Disparities in Diabetes Technology Use and HbA1c in Pediatric Type 1 Diabetes: A Trans-Atlantic Comparison

2020 ◽  
Author(s):  
Ananta Addala ◽  
Marie Auzanneau ◽  
Kellee Miller ◽  
Werner Maier ◽  
Nicole Foster ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Technology Use ◽  
Hemoglobin A1c ◽  
Diabetes Technology ◽  
Design And Methods ◽  
Relationship Of ◽  
The Relationship ◽  
Pediatric Type 1 Diabetes

<b>Objective:</b> As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities. <p> </p> <p><b>Research Design and Methods: </b>Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, US, n=16,457) and Diabetes Prospective Follow-up (DPV, Germany, n=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 HbA1c from 2010-2012 and 2016-2018. </p> <p> </p> <p><b>Results: </b>HbA1c was higher in participants with lower SES (in 2010-2012 & 2016-2018, respectively: 8.0% & 7.8% in Q1 and 7.6% & 7.5% in Q5 for DPV; and 9.0% & 9.3% in Q1 and 7.8% & 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (p<0.001). After adjusting for technology use, results for DPV did not change whereas the increase in T1DX was no longer significant.</p> <p> </p> <p><b>Conclusions: </b>Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX and this difference for HbA1c broadened in the last decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry. </p>

scholarly journals A Decade of Disparities in Diabetes Technology Use and HbA1c in Pediatric Type 1 Diabetes: A Trans-Atlantic Comparison

2020 ◽  
Author(s):  
Ananta Addala ◽  
Marie Auzanneau ◽  
Kellee Miller ◽  
Werner Maier ◽  
Nicole Foster ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Technology Use ◽  
Hemoglobin A1c ◽  
Diabetes Technology ◽  
Design And Methods ◽  
Relationship Of ◽  
The Relationship ◽  
Pediatric Type 1 Diabetes

<b>Objective:</b> As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities. <p> </p> <p><b>Research Design and Methods: </b>Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, US, n=16,457) and Diabetes Prospective Follow-up (DPV, Germany, n=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 HbA1c from 2010-2012 and 2016-2018. </p> <p> </p> <p><b>Results: </b>HbA1c was higher in participants with lower SES (in 2010-2012 & 2016-2018, respectively: 8.0% & 7.8% in Q1 and 7.6% & 7.5% in Q5 for DPV; and 9.0% & 9.3% in Q1 and 7.8% & 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (p<0.001). After adjusting for technology use, results for DPV did not change whereas the increase in T1DX was no longer significant.</p> <p> </p> <p><b>Conclusions: </b>Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX and this difference for HbA1c broadened in the last decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry. </p>

scholarly journals A Decade of Disparities in Diabetes Technology Use and HbA1c in Pediatric Type 1 Diabetes: A Transatlantic Comparison

Diabetes Care ◽  
2020 ◽  
Vol 44 (1) ◽  
pp. 133-140 ◽  
Author(s):  
Ananta Addala ◽  
Marie Auzanneau ◽  
Kellee Miller ◽  
Werner Maier ◽  
Nicole Foster ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Technology Use ◽  
Diabetes Technology ◽  
Transatlantic Comparison ◽  
Pediatric Type 1 Diabetes

Diabetes Technology Experiences Among Latinx and Non-Latinx Youth with Type 1 Diabetes

2021 ◽  
pp. 193229682110292
Author(s):  
David Tsai ◽  
Jaquelin Flores Garcia ◽  
Jennifer L. Fogel ◽  
Choo Phei Wee ◽  
Mark W. Reid ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Young People ◽  
Technology Use ◽  
Private Insurance ◽  
Spanish Speaking ◽  
Positive Attitudes ◽  
Diabetes Technology ◽  
English Speaking ◽  
Continuous Glucose Monitors

Background: Diabetes technologies, such as insulin pumps and continuous glucose monitors (CGM), have been associated with improved glycemic control and increased quality of life for young people with type 1 diabetes (T1D); however, few young people use these devices, especially those from minority ethnic groups. Current literature predominantly focuses on white patients with private insurance and does not report experiences of diverse pediatric patients with limited resources. Methods: To explore potential differences between Latinx and non-Latinx patients, English- and Spanish-speaking young people with T1D ( n = 173, ages 11-25 years) were surveyed to assess attitudes about and barriers to diabetes technologies using the Technology Use Attitudes and Barriers to Device Use questionnaires. Results: Both English- and Spanish-speaking participants who identified as Latinx were more likely to have public insurance ( P = .0001). English-speaking Latinx participants reported higher Hemoglobin A1c values ( P = .003), less CGM use ( P = .002), and more negative attitudes about technology (generally, P = .003; and diabetes-specific, P < .001) than either non-Latinx or Spanish-speaking Latinx participants. Barriers were encountered with equivalent frequency across groups. Conclusions: Latinx English-speaking participants had less positive attitudes toward general and diabetes technology than Latinx Spanish-speaking and non-Latinx English-speaking peers, and differences in CGM use were associated with socioeconomic status. Additional work is needed to design and deliver diabetes interventions that are of interest to and supportive of patients from diverse ethnic and language backgrounds.

scholarly journals Diabetes Technology Use for Management of Type 1 Diabetes Is Associated With Fewer Adverse COVID-19 Outcomes: Findings From the T1D Exchange COVID-19 Surveillance Registry

Diabetes Care ◽  
2021 ◽  
pp. dc210074
Author(s):  
Nudrat Noor ◽  
Osagie Ebekozien ◽  
Laura Levin ◽  
Sheri Stone ◽  
David P. Sparling ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Technology Use ◽  
Diabetes Technology

Sex difference in the relationship of calcium and magnesium excretion to glycaemic control in type 1 diabetes mellitus

1999 ◽  
Vol 283 (1-2) ◽  
pp. 119-128 ◽  
Author(s):  
Iain R. Brown ◽  
Alasdair M. McBain ◽  
John Chalmers ◽  
Ian W. Campbell ◽  
Ewan R. Brown ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Type 1 Diabetes Mellitus ◽  
Sex Difference ◽  
Calcium And Magnesium ◽  
Magnesium Excretion ◽  
Relationship Of ◽  
The Relationship

scholarly journals Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?

2020 ◽  
Author(s):  
Ivana Rabbone ◽  
Riccardo Schiaffini ◽  
Valentino Cherubini ◽  
Claudio Maffeis ◽  
Andrea Scaramuzza ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cross Sectional ◽  
Web Based ◽  
Pediatric Diabetes ◽  
Acute Complications ◽  
Design And Methods ◽  
Second Wave ◽  
Pediatric Type 1 Diabetes ◽  
New Onset

<div><b>Objective</b>: To evaluate if the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the COVID-19 pandemic in Italy.<b><br></b></div><div><b>Research Design and Methods</b>: This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetes ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between February 20 and April 14 in 2019 and 2020. </div><div><b>Results</b>: 53/68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared to 2019. Among those newly diagnosed patient who presented in DKA, the proportion with severe DKA was 44.3% in 2020 vs 36.1% in 2019, p = 0.03. There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed SARS-CoV-2.<b><br></b></div><div><b>Conclusions</b>: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any “second wave” requires strategies to educate and reassure parents about timely ED attendance for non-COVID-19 symptoms.</div>

scholarly journals Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?

2020 ◽  
Author(s):  
Ivana Rabbone ◽  
Riccardo Schiaffini ◽  
Valentino Cherubini ◽  
Claudio Maffeis ◽  
Andrea Scaramuzza ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cross Sectional ◽  
Web Based ◽  
Pediatric Diabetes ◽  
Acute Complications ◽  
Design And Methods ◽  
Second Wave ◽  
Pediatric Type 1 Diabetes ◽  
New Onset

<div><b>Objective</b>: To evaluate if the diagnosis of pediatric type 1 diabetes or its acute complications changed during the early phase of the COVID-19 pandemic in Italy.<b><br></b></div><div><b>Research Design and Methods</b>: This was a cross-sectional, web-based survey of all Italian pediatric diabetes centers to collect diabetes, diabetes ketoacidosis (DKA), and COVID-19 data in patients presenting with new-onset or established type 1 diabetes between February 20 and April 14 in 2019 and 2020. </div><div><b>Results</b>: 53/68 centers (77.9%) responded. There was a 23% reduction in new diabetes cases in 2020 compared to 2019. Among those newly diagnosed patient who presented in DKA, the proportion with severe DKA was 44.3% in 2020 vs 36.1% in 2019, p = 0.03. There were no differences in acute complications. Eight patients with asymptomatic or mild COVID-19 had laboratory-confirmed SARS-CoV-2.<b><br></b></div><div><b>Conclusions</b>: The COVID-19 pandemic might have altered diabetes presentation and DKA severity. Preparing for any “second wave” requires strategies to educate and reassure parents about timely ED attendance for non-COVID-19 symptoms.</div>

scholarly journals Racial-Ethnic Inequity in Young Adults With Type 1 Diabetes

2020 ◽  
Vol 105 (8) ◽  
pp. e2960-e2969 ◽  
Author(s):  
Shivani Agarwal ◽  
Lauren G Kanapka ◽  
Jennifer K Raymond ◽  
Ashby Walker ◽  
Andrea Gerard-Gonzalez ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Young Adults ◽  
Technology Use ◽  
Self Management ◽  
Diabetes Distress ◽  
Diabetes Technology ◽  
Racial Ethnic ◽  
Hispanic White ◽  
Hba1c Levels

Abstract Context Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. Objective To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES). Design Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES. Setting Six diabetes centers across the United States. Participants A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic). Main Outcome Racial-ethnic disparity in HbA1c levels. Results Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P &lt; 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P &lt; 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P &lt; 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black–White glycemic disparity. Conclusion This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors.

Abstract 019: Oxidized LDL and AGE-LDL in Circulating Immune Complexes Strongly Predict Progression of Carotid IMT in Type 1 Diabetes

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Kelly J Hunt ◽  
Nathaniel L Baker ◽  
Patricia Cleary ◽  
Jye-Yu Backlund ◽  
Gabriel Virella ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Type 1 Diabetes ◽  
Immune Complexes ◽  
Internal Carotid ◽  
Oxidized Ldl ◽  
Carotid Imt ◽  
Modified Ldl ◽  
The Relationship

Many studies have demonstrated a relationship between modified LDL and cardiovascular disease. Nonetheless, few studies have examined the relationship between modified LDL immune complexes (IC) and cardiovascular disease, even though the majority of modified LDL in circulation is bound to IC. We report the relationship between circulating concentrations of IC of oxidized LDL (oxLDL-IC), malondialdehyde-LDL (MDA-LDL-IC) and advanced glycation end products-LDL (AGE-LDL-IC) and progression of atherosclerosis over a 12 year period in individuals with type 1 diabetes. OxLDL-IC, AGE-LDL-IC and MDA-LDL-IC levels were measured in a subgroup of 459 patients participating in the Diabetes Control and Complications Trial (DCCT) and it’s follow up study the Epidemiology of Diabetes Interventions and Complications (EDIC). Internal carotid intima-medial thickness (IMT) was measured at EDIC follow-up years 1, 6 and 12. Levels of oxLDL-IC, AGE-LDL-IC and MDA-LDL-IC were moderately correlated with lipid levels [i.e., rho<0.32], but not with age. Modified LDL-IC significantly predicted having elevated internal carotid IMT (i.e., IMT ≥1.00 mm) as well as progression of IMT defined as being in the upper quintile of change from EDIC year 1 to 12 after adjusting for DCCT treatment group [intensive vs. conventional], retinopathy cohort [primary prevention vs. secondary intervention], age, gender, diabetes duration, albumin excretion rate, LDL, HDL, SBP, smoking status and IMT reader (Table). Relative to those in the lowest quartile, individuals in the upper quartile of oxLDL-IC had a 3.7-fold increased odds (CI: 1.72, 7.94) of having IMT ≥ 1.00 mm and had a 6.1-fold increased odds (CI: 2.57, 14.6) of having significant IMT progression. Parallel odds ratios for AGE-LDL-IC were 3.26 (CI: 1.57, 6.79) and 5.31 (CI: 2.23, 12.6), while results for MDA-LDL-IC were not as strong. Our study indicates that high levels of oxLDL-IC and AGE-LDL-IC are important predictors of carotid intima-medial thickening in patients with type 1 diabetes.

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