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Addala, A.* ; Auzanneau, M.* ; Miller, K.* ; Maier, W. ; Foster, N.* ; Kapellen, T.* ; Walker, A.* ; Rosenbauer, J.* ; Maahs, D.M.* ; Holl, R.W.*

A decade of disparities in diabetes technology use and HbA1c in pediatric type 1 diabetes: A transatlantic comparison.

Diabetes Care 44, 133-140 (2020)
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OBJECTIVE: As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized that an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities. RESEARCH DESIGN AND METHODS: Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, U.S., n = 16,457) and Diabetes Prospective Follow-up (DPV, Germany, n = 39,836) registries were categorized into lowest (Q1) to highest (Q5) SES quintiles. Multiple regression analyses compared the relationship of SES quintiles with diabetes technology use and HbA1c from 2010-2012 to 2016-2018. RESULTS: HbA1c was higher in participants with lower SES (in 2010-2012 and 2016-2018, respectively: 8.0% and 7.8% in Q1 and 7.6% and 7.5% in Q5 for DPV; 9.0% and 9.3% in Q1 and 7.8% and 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (P < 0.001). After adjusting for technology use, results for DPV did not change, whereas the increase in T1DX was no longer significant. CONCLUSIONS: Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX, and this difference for HbA1c broadened in the past decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry.
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Publikationstyp Artikel: Journalartikel
Dokumenttyp Wissenschaftlicher Artikel
Schlagwörter Multiple Deprivation; Socioeconomic-status; United-states; T1d Exchange; Children; Care; Dpv; Ketoacidosis; Adolescents; Management
ISSN (print) / ISBN 0149-5992
e-ISSN 1935-5548
Zeitschrift Diabetes Care
Quellenangaben Band: 44, Heft: 1, Seiten: 133-140 Artikelnummer: , Supplement: ,
Verlag American Diabetes Association
Verlagsort Alexandria, Va.
Begutachtungsstatus Peer reviewed
Förderungen P30DK116074
German Center for Diabetes Research
German Diabetes Association
European Foundation for the Study of Diabetes
Maternal and Child Health Research Institute
K12 fund at Stanford University
National Institutes of Health
National Science Foundation
Helmsley Charitable Trust
Leona M. and Harry B. Helmsley Charitable Trust