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 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% 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% were Hispanic and
7% 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% among children younger than
19 years with type 1 diabetes, according to the American Diabetes
Association.
That measure was 9.6% among black children. That compared to 8.4%
among white kids and 8.7% 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.”
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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.”
SOURCE: http://bit.ly/17igU4f
and http://bit.ly/17igYkG
Pediatrics 2015.
[© 2015 Thomson Reuters. All rights
reserved.] Copyright 2015 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
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