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Racial differences in neighborhood disadvantage, inflammation and metabolic control in black and white pediatric type 1 diabetes patients
Author(s) -
Coulon Sara J.,
VelascoGonzalez Cruz,
Scribner Richard,
Park Chi L.,
Gomez Ricardo,
Vargas Alfonso,
Stender Sarah,
Zabaleta Jovanny,
Clesi Patrice,
Chalew Stuart A.,
Hempe James M.
Publication year - 2017
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12361
Subject(s) - medicine , confounding , diabetes mellitus , type 2 diabetes , population , metabolic control analysis , demography , racial differences , endocrinology , environmental health , ethnic group , sociology , anthropology
Background Racial variation in the relationship between blood glucose and hemoglobin A1c ( HbA1c ) complicates diabetes diagnosis and management in racially mixed populations. Understanding why HbA1c is persistently higher in blacks than whites could help reduce racial disparity in diabetes outcomes. Objective Test the hypothesis that neighborhood disadvantage is associated with inflammation and poor metabolic control in a racially mixed population of pediatric type 1 diabetes patients. Methods Patients (n = 86, 53 white, 33 black) were recruited from diabetes clinics. Self‐monitored mean blood glucose ( MBG ) was downloaded from patient glucose meters. Blood was collected for analysis of HbA1c and C‐reactive protein ( CRP ). Patient addresses and census data were used to calculate a concentrated disadvantage index ( CDI ). High CDI reflects characteristics of disadvantaged neighborhoods. Results HbA1c and MBG were higher (p < 0.0001) in blacks [10.4% (90.3 mmol/mol), 255 mg/dL] than whites [8.9% (73.9 mmol/mol), 198 mg/dL). CDI was higher in blacks (p < 0.0001) and positively correlated with HbA1c (r = 0.40, p = 0.0002) and MBG (r = 0.35, p = 0.0011) unless controlled for race. CDI was positively associated with CRP by linear regression within racial groups. CRP was not different between racial groups, and was not correlated with MBG , but was positively correlated with HbA1c when controlled for race (p = 0.04). Conclusions Neighborhood disadvantage was associated with inflammation and poor metabolic control in pediatric type 1 diabetes patients. Marked racial differences in potential confounding factors precluded differentiation between genetic and environmental effects. Future studies should recruit patients matched for neighborhood characteristics and treatment regimen to more comprehensively assess racial variation in HbA1c .