Racial and Socioeconomic Disparities in Meeting Goals of Care in Adults with Type 1 Diabetes

Abstract

Racial and socioeconomic (SES) disparities exist in youth with type 1 diabetes (T1D). Black youth have worse glycemic control, higher frequency of DKA, and less use of insulin pump therapy. However, data is sparse on whether racial and SES disparities in meeting ABC (A1c, Blood pressure, Cholesterol) goals of care exist in adulthood, when financial independence, access to healthcare, and cognitive maturity change. We used T1D Exchange Network data, which enrolled youth and adults with T1D from 73 practices. We include adults (≥ 18 years) with available race/ethnicity data. Of 12,746 adults, 90% where white, 4.8% black and 5.7% Hispanic; annual household income in 13% was <$25K, 20% was $25-50K, 34% was $50-100K, and 33% was >$100K. Logistic regression showed increased probability of poor glycemic control (A1c >7%) with annual income <$25K (OR 2.29, 95% CI [1.92,1.74]), being black (OR 3.05, 95% CI [2.09,4.43]) or Hispanic (OR 1.42, 95% CI [1.10, 1.82]). Outcomes were similar in achieving SBP <140mmHg and LDL <100mg/dL. Data stratified by income showed significant disparities among races, with fewer black and Hispanic adults achieving ABC goals compared to whites. There were no differences in mortality. Racial and SES disparities exist in adults with T1D. Racial disparities are evident after adjusting for income, suggesting socio-ecological factors play a role in achieving optimal diabetes care in minority populations. White, non-HispanicBlack, non-HispanicHispanicp-value>$100K N=2924N=45N=77A1c <7%, n (%)920 (32)4 (9.1)14 (22)<0.001SBP <140 mmHg, n (%)2736 (95)34 (79)69 (92)<0.001LDL <100 mg/dL, n (%)1690 (69)24 (57)43 (67)0.23No smoking, n (%)2218 (95)37 (95)63 (90)0.19$50K-100KN=2914N=99N=105A1c <7%, n (%)751 (26)13 (14)27 (26)0.02SBP <140 mmHg, n (%)2695 (93)88 (89)99 (95)0.20LDL <100 mg/dL, n (%)1607 (65)53 (63)48 (57)0.27No smoking, n (%)2103 (90)87 (97)84 (97)0.01$25K-50KN=1590N=96N=134A1c <7%, n (%)333 (21)8 (8.4)16 (12)<0.001SBP <140 mmHg, n (%)1439 (91)84 (88)124 (93)0.37LDL <100 mg/dL, n (%)828 (65)43 (62)56 (59)0.49No smoking, n (%)1049 (83)76 (87)101 (85)0.52<$25KN=964N=125N=149A1c <7%, n (%)159 (17)6 (5.1)19 (13)0.001SBP <140 mmHg, n (%)890 (93)97 (81)141 (96)<0.001LDL <100 mg/dL, n (%)460 (65)55 (60)61 (53)0.04No smoking, n (%)565 (75)93 (79)123 (89)0.001 Disclosure J. Haw: None. L. Peng: None. F.J. Pasquel: Consultant; Self; Merck Sharp & Dohme Corp., Sanofi, Boehringer Ingelheim Pharmaceuticals, Inc. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca. M. Fayfman: None. G. Davis: None. G.E. Umpierrez: Research Support; Self; Sanofi US, Merck & Co., Inc., Novo Nordisk Inc., AstraZeneca. Advisory Panel; Self; Sanofi, Intarcia Therapeutics, Inc..