Racial and ethnic disparities in comorbidities in youth with type 2 Diabetes in the Pediatric Diabetes Consortium (PDC)

Authors: BACHA, FIDA - Children'S Nutrition Research Center (CNRC); CHENG, PEIYAO - Jaeb Center For Health Research; GAL, ROBIN - Jaeb Center For Health Research; BEAULIEU, LINDSEY - Jaeb Center For Health Research; KOLLMAN, CRAIG - Jaeb Center For Health Research; ADOLPH, ANNE - Baylor College Of Medicine; SHOEMAKER, ASHLEY - Vanderbilt University Medical Center; WOLF, RISA - Johns Hopkins University; KLINGENSMITH, GEORGEANNA - University Of Colorado; TAMBORLANE, WILLIAM - Yale University

Submitted to: Diabetes Care
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 6/25/2021
Publication Date: 10/1/2021
Citation: Bacha, F., Cheng, P., Gal, R.L., Beaulieu, L.C., Kollman, C., Adolph, A., Shoemaker, A.H., Wolf, R., Klingensmith, G.J., Tamborlane, W.V. 2021. Racial and ethnic disparities in comorbidities in youth with type 2 Diabetes in the Pediatric Diabetes Consortium (PDC). Diabetes Care. 44:2245-2251. https://doi.org/10.2337/dc21-0143.
DOI: https://doi.org/10.2337/dc21-0143

Interpretive Summary: Type 2 diabetes is more common in youth of racial-ethnic minority. Disparities in health outcomes in these youth are not clear. Investigators in Houston, Texas examined racial-ethnic differences in the presentation and comorbidities in 1,217 youth with type 2 diabetes. Non-Hispanic Black children were three times as likely to present with diabetic ketoacidosis compared to Hispanic and non-Hispanic White children. Non-Hispanic black and Hispanic children continue to have worse diabetes control over time compared to non-Hispanic White youth. Diabetes complications including early kidney disease, elevated lipids and elevated blood pressure were highly prevalent in all racial-ethnic groups. Non-alcoholic fatty liver disease was less common in non-Hispanic Black compared with the two other groups. These findings suggest the need for greater efforts to address the racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.

Technical Abstract: Type 2 diabetes in the U.S. is more prevalent in youth of minority racial-ethnic background, but disparities in health outcomes have not been examined in this population. We examined racial-ethnic differences in the initial presentation and subsequent comorbidities in 1,217 youth with type 2 diabetes (63% girls) enrolled in the Pediatric Diabetes Consortium (PDC) Registry from February 2012 to June 2018. Demographic and clinical data were collected from medical records and participant self-report. Overall, the mean age at presentation was 13.4 +/- 2.4 years, and BMI was 35.0 +/- 9.4 kg/m2. HbA1C was higher and C-peptide was lower in non-Hispanic Black (NHB) and Hispanic (H) youth compared with non-Hispanic White (NHW) youth. NHB were three times as likely to present in diabetic ketoacidosis (19%) versus NHW (6.3%) and H (7.5%), and NHB and H both had a worse HbA1C trajectory compared with NHW peers. Microalbuminuria was documented in 11%, hypertension in 34%, and dyslipidemia in 42% of Registry participants, with no significant difference among racial-ethnic groups. Nonalcoholic fatty liver disease (NAFLD) was diagnosed in 9% and 11% of H and NHW, respectively, versus 2% in NHB. NHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA1C trajectories compared with NHW. Comorbidities exist in a large percentage of these youth independent of race-ethnicity, except for NAFLD being less prevalent in NHB. Greater efforts are needed to mitigate racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.