Abstract
ObjectivesResearch and theory suggests that socioeconomic status may affect diabetes control. We investigated the effect of socioeconomic status and ethnicity on glycated hemoglobin (HbA1c) in Arab and Jewish children with type 1 diabetes mellitus in northern Israel.MethodsData were collected from medical records of 80 Arab and 119 Jewish children attending a pediatric diabetes clinic in a tertiary health care center. Multivariate regression analysis was used to assess factors independently affecting HbA1c level.ResultsMean age was 12.9±4.7 years. Arab families had more children compared to Jewish families (3.7±1.5 versus 2.9±1.2, respectively, P=0.0007). Academic education was significantly less common in Arab families (25% versus 66.2%, respectively, P=0.0001). Income of Jewish parents was significantly higher compared to that of Arab parents (7,868±2,018 versus 5,129±906 NIS/month, respectively, P=0.0001). Mean age at diagnosis of diabetes was 9.6±4.6 years and disease duration was 3.4±2.3 years in both groups. Half of Arab and Jewish children were treated with multiple insulin injections and half with insulin pumps. Mean number of self-glucose testing/day was higher in Jewish children than in Arab children (4.7±2.5 versus 4.0±1.5, respectively, P=0.033). Mean HbA1c was above recommendations, 9.5% (12.6 mmol/L) in Arab children and 8.7% (11.3 mmol/L) in Jewish children (P=0.004). In multivariate analysis, disease duration (P=0.010) and ethnicity (P=0.034 for Arabs versus Jews) were independently associated with HbA1c.ConclusionsBoth Arab and Jewish children failed to meet HbA1c goals, but this effect was significantly greater for Arabs. Ethnicity remained a predictor of failure even following adjustment for potential confounders.
Highlights
Type 1 diabetes mellitus (T1DM) is a common chronic disease in children and adolescents
Half of Arab and Jewish children were treated with multiple insulin injections and half with insulin pumps
Mean number of self-glucose testing/day was higher in Jewish children than in Arab children (4.7±2.5 versus 4.0±1.5, respectively, P=0.033)
Summary
Type 1 diabetes mellitus (T1DM) is a common chronic disease in children and adolescents. Immune state and trait, infectious morbidity, and environmental factors are all thought to contribute to the development of T1DM.[5,6] Due to the fact that children need to constantly inject insulin and monitor their blood glucose levels, involvement of parents, lifestyle adaptation, and good communication with the treating physicians, nurses, and dieticians are essential.[7] The responsibility for attaining the appropriate glycated hemoglobin (HbA1c) goal rests upon the children and their caregivers, with close and continuing support from the clinic.[8] Reaching and maintaining the metabolic goals is of particular importance as studies have shown that attaining them decreases microvascular complications.[9] the control of T1DM is influenced by factors related to the patients and to their caregivers. In some studies an effect of race was demonstrated, perhaps relating to genetic factors, while other studies failed to demonstrate an added effect of race over other sociodemographic factors.[18,19]
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