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Developmental Trajectories of Metabolic Control among White, Black, and Hispanic Youth with Type 1 Diabetes

Objective: To examine race/ethnicity and neighborhood income differences in longitudinal patterns of deterioration in hemoglobin A1c (HbA1c) values among youth (age 10 to 18 years) with type 1 diabetes.

Study Design:  A sample of 225 youth (50.2% female), including 81 White, 81 Black, and 63 Hispanic youth with type 1 diabetes, was matched initially on age and sex. Neighborhood median family income was obtained through public census databases. Self-identified race/ethnicity and all HbA1c values (grand mean, 9.09% ± 2.02%) available in patients' medical records between age 10 and 18 years were recorded and analyzed.

Results: Hierarchical linear modeling revealed age-related deterioration in HbA1c values that differed by race/ethnicity and income. Controlling for income, White and Hispanic youth had similar HbA1c values at the start of adolescence (age 10) and demonstrated similar rates of deterioration across adolescence. Blacks had higher initial HbA1c values compared with Whites and Hispanics, but a similar rate of deterioration. Higher neighborhood income was associated with slower deterioration in HbA1c value among White teens, but not among Hispanic or Black teens.

Conclusions: Longitudinally, Black youth appear to experience disproportionate risks compared with White and Hispanic youth when income is statistically controlled. Neither Black nor Hispanic youth appear to benefit from living in higher-income neighborhoods.

Jenny T. Wang, PhD, Deborah J. Wiebe, PhD, MPH, Perrin C. White, MD
Year Published: 
Online 17 May 2011
Volume (issue) pages: 
2011 Oct;159(4):571-6. doi: 10.1016/j.jpeds.2011.03.053.
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