Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes in the Pediatric Diabetes Consortium (PDC)

Fida Bacha; Peiyao Cheng; Robin L Gal; Lindsey C Beaulieu; Craig Kollman; Anne Adolph; Ashley H Shoemaker; Risa Wolf; Georgeanna J Klingensmith; William V Tamborlane

doi:10.2337/dc21-0143

Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes in the Pediatric Diabetes Consortium (PDC)

Diabetes Care. 2021 Sep 2:dc210143. doi: 10.2337/dc21-0143. Online ahead of print.

Authors

Affiliations

¹ Baylor College of Medicine, Houston, TX fbacha@bcm.edu.
² Jaeb Center for Health Research, Tampa, FL.
³ Baylor College of Medicine, Houston, TX.
⁴ Vanderbilt University School of Medicine, Nashville, TN.
⁵ The Johns Hopkins Hospital, Baltimore, MD.
⁶ Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, CO.
⁷ Pediatric Endocrinology, Yale University, New Haven, CT.

PMID: 34475033
DOI: 10.2337/dc21-0143

Abstract

Background: 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.

Research design and methods: 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.

Results: Overall, the mean age at presentation was 13.4 ± 2.4 years, and BMI was 35.0 ± 9.4 kg/m². HbA_1c 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 HbA_1c 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.

Conclusions: NHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA_1c 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.