The Impact of Racial and Ethnic Health Disparities in Diabetes Management on Clinical Outcomes: A Reinforcement Learning Analysis of Health Inequity Among Youth and Young Adults in the SEARCH for Diabetes in Youth Study

<a>Objective: </a>To estimate difference in population-level glycemic control and the emergence of diabetes complications given a theoretical scenario whereby non-White youth and young adults (YYA) with type 1 diabetes (T1D) receive and follow an equivalent distribution of diabetes treatment regimens as non-Hispanic White YYA. Research Design and Methods: Longitudinal data from YYA diagnosed 2002-2005 in the SEARCH for Diabetes in Youth Study were analyzed. Based on self-reported race/ethnicity, YYA were classified as non-White race or Hispanic ethnicity (non-White subgroup) versus non-Hispanic White race (White subgroup). <a>In the White versus non-White subgroups, propensity scores model estimated treatment regimens, including patterns of insulin modality, self-monitored glucose frequency, and continuous glucose monitoring use.</a> An analysis based on policy evaluation technique in reinforcement learning estimated the effect of each treatment regimen on hemoglobin A1c (HbA1c) and diabetes complications for non-White YYA. Results: The study included n=978 YYA. The sample was 47.5% female and77.5% non-Hispanic White, with mean age 12.8±2.4 years at diagnosis. The estimated population mean of longitudinal average HbA1c over visits was 9.2% and 8.2% for the non-White and White subgroup, respectively (difference=0.9%). Within the non-White subgroup, mean HbA1c across visits was estimated to decrease by 0.33% (95%CI: -0.45%, -0.21%) if these YYA received the distribution of diabetes treatment regimens of the White subgroup, explaining approximately 35% of the estimated difference between the two subgroups. The non-White subgroup was also estimated to have a lower risk of developing diabetic retinopathy, diabetic kidney disease, and peripheral neuropathy with the White youth treatment regimen distribution (p<0.05), although the low proportion of YYA who developed complications limited statistical power for risk estimations. Conclusions: Mathematically modeling an equalized distribution of T1D self-management tools and technology accounted for part but not all disparities in glycemic control between non-White and White YYA, underscoring the complexity of race/ethnicity-based health inequity.

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Demographic Correlates of Short-Term Mortality Among Youth and Young Adults With Youth-Onset Diabetes Diagnosed From 2002 to 2015: The SEARCH for Diabetes in Youth Study

10.2337/figshare.16606313.v1 ◽

2021 ◽

Author(s):

Jean M Lawrence ◽

Kristi Reynolds ◽

Sharon H Saydah ◽

Amy Mottl ◽

Catherine Pihoker ◽

...

Keyword(s):

Excess Mortality ◽

Diabetes Type ◽

Short Term ◽

Short Term Mortality ◽

Youth And Young Adults ◽

Race Ethnicity ◽

Youth Study ◽

Diabetes In Youth

OBJECTIVE: To examine short-term mortality and cause of death among youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS: We included 19,717 YYA’s newly-diagnosed with diabetes before age 20 from 1/1/2002–12/31/2015 enrolled in the SEARCH for Diabetes in Youth Study. Of these, 14,721 had type 1; 4,141 type 2; 551 secondary and 304 other/unknown diabetes type. Cases were linked with the National Death Index through 12/31/2017. We calculated standardized mortality ratios (SMR) and 95% CIs based on age, sex, and race/ethnicity for state and county population areas and examined underlying causes of death. RESULTS: During 170,148 person-years (PY) (median follow-up=8.5 years), 283 individuals died: 133 with type 1 (103.0/100,000 PY), 55 with type 2 (161.5/100,000 PY), 87 with secondary (1,952/100,000 PY) and 8 with other/unknown diabetes type (312.3/100,000 PY). SMRs (95% CI) for the first three groups were 1.5 (1.2-1.8), 2.3 (1.7-3.0) and 28.0 (22.4-34.6), respectively. Diabetes was the underlying cause of death for 42.1%, 9.1% and 4.6% of deaths, respectively. The SMR was greater for type 2 than for type 1 diabetes (p<0.001). SMRs were significantly higher for ages <20 years, non-Hispanic White and Hispanic individuals and females with type 1 diabetes and for ages <25 years, all race/ethnic minority groups and both sexes with type 2 diabetes. CONCLUSION: Excess mortality was observed among YYA for each type of diabetes with differences in risk associated with diabetes type, age, race/ethnicity, and sex. The root causes of excess mortality among YYAs with diabetes merits further study.

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Trends in Glycemic Control Among Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study

Diabetes Care ◽

10.2337/dc21-0507 ◽

2022 ◽

Author(s):

Faisal S. Malik ◽

Katherine A. Sauder ◽

Scott Isom ◽

Beth A. Reboussin ◽

Dana Dabelea ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Age Groups ◽

Youth And Young Adults ◽

Race Ethnicity ◽

Youth Study ◽

Diabetes In Youth

OBJECTIVES To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS The study included 6,369 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods of 2002–2007, 2008–2013, and 2014–2019, diabetes durations of 1–4, 5–9, and ≥10 years, and age groups of 1–9, 10–14, 15–19, 20–24, and ≥25 years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen, and diabetes duration, overall and stratified for each diabetes duration and age group. RESULTS Adjusted mean HbA1c for the 2014–2019 cohort of YYA with type 1 diabetes was 8.8 ± 0.04%. YYA with type 1 diabetes in the 10–14-, 15–19-, and 20–24-year-old age groups from the 2014–2019 cohort had worse glycemic control than the 2002–2007 cohort. Race/ethnicity, household income, and treatment regimen predicted differences in glycemic control in participants with type 1 diabetes from the 2014–2019 cohort. Adjusted mean HbA1c was 8.6 ± 0.12% for 2014–2019 YYA with type 2 diabetes. Participants aged ≥25 years with type 2 diabetes had worse glycemic control relative to the 2008–2013 cohort. Only treatment regimen was associated with differences in glycemic control in participants with type 2 diabetes. CONCLUSIONS Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.

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Demographic Correlates of Short-Term Mortality Among Youth and Young Adults With Youth-Onset Diabetes Diagnosed From 2002 to 2015: The SEARCH for Diabetes in Youth Study

10.2337/figshare.16606313 ◽

2021 ◽

Author(s):

Jean M Lawrence ◽

Kristi Reynolds ◽

Sharon H Saydah ◽

Amy Mottl ◽

Catherine Pihoker ◽

...

Keyword(s):

Excess Mortality ◽

Diabetes Type ◽

Short Term ◽

Short Term Mortality ◽

Youth And Young Adults ◽

Race Ethnicity ◽

Youth Study ◽

Diabetes In Youth

OBJECTIVE: To examine short-term mortality and cause of death among youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS: We included 19,717 YYA’s newly-diagnosed with diabetes before age 20 from 1/1/2002–12/31/2015 enrolled in the SEARCH for Diabetes in Youth Study. Of these, 14,721 had type 1; 4,141 type 2; 551 secondary and 304 other/unknown diabetes type. Cases were linked with the National Death Index through 12/31/2017. We calculated standardized mortality ratios (SMR) and 95% CIs based on age, sex, and race/ethnicity for state and county population areas and examined underlying causes of death. RESULTS: During 170,148 person-years (PY) (median follow-up=8.5 years), 283 individuals died: 133 with type 1 (103.0/100,000 PY), 55 with type 2 (161.5/100,000 PY), 87 with secondary (1,952/100,000 PY) and 8 with other/unknown diabetes type (312.3/100,000 PY). SMRs (95% CI) for the first three groups were 1.5 (1.2-1.8), 2.3 (1.7-3.0) and 28.0 (22.4-34.6), respectively. Diabetes was the underlying cause of death for 42.1%, 9.1% and 4.6% of deaths, respectively. The SMR was greater for type 2 than for type 1 diabetes (p<0.001). SMRs were significantly higher for ages <20 years, non-Hispanic White and Hispanic individuals and females with type 1 diabetes and for ages <25 years, all race/ethnic minority groups and both sexes with type 2 diabetes. CONCLUSION: Excess mortality was observed among YYA for each type of diabetes with differences in risk associated with diabetes type, age, race/ethnicity, and sex. The root causes of excess mortality among YYAs with diabetes merits further study.

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A cross sectional study to compare cardiac structure and diastolic function in adolescents and young adults with youth-onset type 1 and type 2 diabetes: The SEARCH for Diabetes in Youth Study

Cardiovascular Diabetology ◽

10.1186/s12933-021-01328-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Amy S. Shah ◽

Scott Isom ◽

Dana Dabelea ◽

Ralph D’Agostino ◽

Lawrence M. Dolan ◽

...

Keyword(s):

Risk Factors ◽

Diastolic Function ◽

Healthy Controls ◽

Cross Sectional ◽

Factors Associated ◽

Youth Study ◽

Hispanic White ◽

Diabetes In Youth

Abstract Aims To compare left ventricular structure (LV) and diastolic function in young adults with youth- onset diabetes by type, determine the prevalence of abnormal diastolic function by diabetes type using published values from age similar healthy controls, and examine the risk factors associated with diastolic function. Methods In a cross sectional analysis we compared LV structure and diastolic function from two dimensional echocardiogram in participants with type 1 (T1D) and type 2 diabetes (T2D) who participated in the SEARCH for Diabetes in Youth Study. Linear models were used to examine the risk factors associated with worse diastolic function. Results Of 479 participants studied, 258 had T1D (mean age 21.2 ± 5.2 years, 60.5% non-Hispanic white, 53.9% female) and 221 had T2D (mean age 24.8 ± 4.3 years, 24.4% non-Hispanic white, 73.8% female). Median diabetes duration was 11.6 years. Participants with T2D had greater LV mass index and worse diastolic function that persisted after adjustment for differences in risk factors compared with participants with T1D (all p < 0.05). Abnormal diastolic function, quantified using healthy controls, was pronounced in both groups but greater in those with T2D than T1D (T2D: 57.7% vs T1D: 47.2%, respectively), p < 0.05. Risk factors associated with worse diastolic function included older age at diabetes diagnosis, female sex, higher BP, heart rate and HbA1c and longer diabetes duration. Conclusions LV structure and diastolic function is worse in individuals with T2D compared to T1D. However, abnormal diastolic function in seen in both groups compared to published values from age similar healthy controls.

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Prevalence and Predictors of Household Food Insecurity and Supplemental Nutrition Assistance Program Use in Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study

10.2337/figshare.16873354 ◽

2021 ◽

Author(s):

Faisal S. Malik ◽

Angela D. Liese ◽

Beth A. Reboussin ◽

Katherine A. Sauder ◽

Edward A. Frongillo ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Assistance Program ◽

Household Food ◽

Youth And Young Adults ◽

Nutrition Assistance ◽

Youth Study ◽

Hispanic White

<a>OBJECTIVES: To assess the prevalence of household food insecurity (HFI) and Supplemental Nutrition Assistance Program (SNAP) participation in youth and young adults (YYA) with diabetes overall, by type, and sociodemographic characteristics.</a> RESEARCH DESIGN AND METHODS: The study included participants with youth-onset type 1 diabetes and type 2 diabetes from the SEARCH for Diabetes in Youth study. HFI was assessed using the 18-item U.S. Household Food Security Survey Module (HFSSM) administered from 2016-2019; ³3 affirmations on the HFSSM were considered indicative of HFI. Participants were asked about SNAP participation. Chi-square tests were used to assess whether the prevalence of HFI and SNAP participation differed by diabetes type. Multivariable logistic regression models were used to examine differences in HFI by participant characteristics. RESULTS: Of 2561 respondents (age range 10-35 years; 79.6% ≤ 25 years), 2177 had type 1 diabetes (mean age 21.0 years, 71.8% non-Hispanic white, 11.8% non-Hispanic black, 13.3% Hispanic, 3.1% other) and 384 had type 2 diabetes (mean age 24.7 years, 18.8% non-Hispanic white, 45.8% non-Hispanic black, 23.7% Hispanic, 18.7% other). The overall prevalence of HFI was 19.7% (95% CI 18.1, 21.2). HFI was more prevalent in type 2 diabetes than type 1 diabetes (30.7% vs. 17.7%, p< 0.01). In multivariable regression models, YYA on Medicaid/Medicare or without insurance, with lower parental education, and with lower household income had greater odds of experiencing HFI. SNAP participation was 14.1% (95% CI 12.7, 15.5) with higher participation among those with type 2 diabetes compared to type 1 diabetes (34.8% vs. 10.7%; p<0.001). CONCLUSIONS: Almost 1 in 3 YYA with type 2 diabetes and more than 1 in 6 with type 1 diabetes reported HFI in the past year, a significantly higher prevalence than the general U.S. population.

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Demographic Correlates of Short-Term Mortality Among Youth and Young Adults With Youth-Onset Diabetes Diagnosed From 2002 to 2015: The SEARCH for Diabetes in Youth Study

Diabetes Care ◽

10.2337/dc21-0728 ◽

2021 ◽

pp. dc210728

Author(s):

Jean M. Lawrence ◽

Kristi Reynolds ◽

Sharon H. Saydah ◽

Amy Mottl ◽

Catherine Pihoker ◽

...

Keyword(s):

Young Adults ◽

Short Term ◽

Onset Diabetes ◽

Demographic Correlates ◽

Short Term Mortality ◽

Youth And Young Adults ◽

Youth Study ◽

Diabetes In Youth

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Trends in Glycemic among Youth with Diabetes: The SEARCH for Diabetes in Youth Study

10.2337/figshare.17052590.v1 ◽

2022 ◽

Author(s):

Faisal S. Malik ◽

Katherine A. Sauder ◽

Scott Isom ◽

Beth A. Reboussin ◽

Dana Dabelea ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Household Income ◽

Age Groups ◽

Race Ethnicity ◽

Youth Study ◽

Diabetes In Youth

OBJECTIVES: To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS: The study included 6,492 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods 2002-2007, 2008-2013 and 2014-2019, diabetes durations of 1-4, 5-9, and 10+ years, and age groups 1-9, 10-14, 15-19, 20-24, 25+ years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen and diabetes duration, overall and stratified for each duration and age group. RESULTS: Adjusted mean HbA1c for the 2014-2019 cohort of YYA with type 1 diabetes was 8.8%±0.04%. YYA with type 1 diabetes in the 10-14, 15-19, and 20-24 age groups from the 2014-2019 cohort had worse glycemic control than the 2002-2007 cohort. Race/ethnicity, household income and treatment regimen predicted differences in glycemic control in 2014-2019 type 1 diabetes participants. Adjusted mean HbA1c was 8.6%±0.12% for 2014-2019 YYA with type 2 diabetes. Participants age 25+ with type 2 diabetes had worse glycemic control relative to the 2008-2013 cohort. Only treatment regimen was associated with differences in glycemic control in type 2 diabetes participants. CONCLUSIONS: Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.

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