Racial differences in neighborhood disadvantage, inflammation and metabolic control in black and white pediatric type 1 diabetes patients

Abstract

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.

Keywords: hemoglobin A1c; inflammation; racial bias; socioeconomic factors; type 1 diabetes mellitus.

Conflict of interest statement

The authors declare that there is no duality of interest associated with this manuscript.

© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Figures

Fig. 1

Linear regression analysis of concentrated disadvantage index (CDI) vs. HbA1c in the mixed race study sample (A) and separately by racial subgroup (B).

Fig. 2

Linear regression analysis of concentrated disadvantage index (CDI) vs. C-reactive protein (CRP) in the mixed race study sample (A) and separately by racial subgroup (B).

Fig. 3

Linear regression analysis of C-reactive protein (CRP) vs. HbA1c in the mixed race study sample (A) and separately by racial subgroup (B).