Racial gaps in diabetes not tied to social, economic status

Social and economic status does not explain the racial gaps in the care and outcomes of kids with type 1 diabetes, according to a new study.

The finding suggests researchers look to other factors that may explain the racial gap in type 1 diabetes care, such as the perceptions of doctors and families, write the researchers in the journal Pediatrics February 16.

Previous studies done in much smaller populations have had somewhat similar findings, wrote lead author Dr. Steven Willi of the Children’s Hospital of Philadelphia in an email to Reuters Health.

More than 29 million Americans have diabetes, 5 percent of who have type 1, according to the Centers for Disease Control and Prevention.

Willi and his coauthors used data from more than 10,000 kids under age 18 in a type 1 diabetes registry, following them for at least a year. The majority of the kids were white, but 11 percent were Hispanic and 7 percent were black.

The researchers say children who were black tended to have worse control over their diabetes, compared to white and Hispanic children.

Mean hemoglobin A1c should be below 7.5 percent among children younger than 19 years with type 1 diabetes, according to the American Diabetes Association.

That measure was 9.6 percent among black children. That compared to 8.4 percent among white kids and 8.7 percent among Hispanic kids.

Black children also had more complications from type 1 diabetes, compared to white and Hispanic children, the researchers found.

The racial gap in diabetes management remained even after the researchers adjusted for factors that may influence diabetes management, including the social and economic status of the children’s families.

The researchers also found that black children were less likely to have insulin pumps, compared to white and Hispanic children after adjusting for their families’ social and economic status.

Willi said other possible explanations for the racial disparity in diabetes care and outcomes include cultural differences in acceptance of insulin pumps, the interaction between black diabetes patients and their primarily white healthcare providers, or in fact that providers have a racial bias in the diabetes care relationship.

“I do not feel that diabetes care providers are overtly racist in any way,” Willi stressed. “However, I do have lingering concerns that subliminal racial bias still exists in this country, and the medical community is not immune to this.”

There may be another explanation, according to Dr. Stuart Chalew of Children’s Hospital of New Orleans, who wrote an editorial accompanying the results.

“What is hemoglobin A1c?” Chalew said. “Doctors will say it’s the mean blood glucose,” but that’s a simplified way to look at it, he said. In previous studies, even when black and white patients have the same blood sugar levels, they can have higher A1c, which may be due to genetic differences, he said.

That issue wasn’t really assessed in the new paper, although the results are still valuable since the sample of kids was so large, he told Reuters Health by phone.

A1c measurements may be overestimating blood sugar for black patients, leading them to take more insulin and inadvertently push their blood sugar too low, which would explain the higher rate of complications, he said.

Closing the racial gap among people with type 1 diabetes will hinge on uncovering the root cause.

“Of course, healthcare providers should continue to strive for cultural sensitivity in their practice,” Willi said. “Finally, if this gap is due, in part, to subliminal racial bias, it will be helpful to recognize that this bias exists, and actively work toward its eradication.”