Enrollment of underrepresented racial and ethnic groups in the Rare and Atypical Diabetes Network (RADIANT)

Mustafa Tosur; Laura Gandolfo; Ashok Balasubramanyam; Rochelle N Naylor; Toni I Pollin; Neda Rasouli; Sara J Cromer; John B Buse; Maria J Redondo; RADIANT Study Group

doi:10.1017/cts.2022.529

Enrollment of underrepresented racial and ethnic groups in the Rare and Atypical Diabetes Network (RADIANT)

J Clin Transl Sci. 2023 Jan 23;7(1):e47. doi: 10.1017/cts.2022.529. eCollection 2023.

Authors

Affiliations

¹ Department of Pediatrics, The Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
² Children's Nutrition Research Center, USDA/ARS, Houston, TX, USA.
³ Health Informatics Institute, University of South Florida, Tampa, FL, USA.
⁴ Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA.
⁵ Division of Adult and Pediatric Endocrinology Diabetes, and Metabolism, Departments of Pediatrics and Medicine, University of Chicago, Chicago, IL, USA.
⁶ Departments of Medicine and Epidemiology & Public Health, University of Maryland, Baltimore, MD, USA.
⁷ Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado, Aurora, CO, USA.
⁸ Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁹ Division of Endocrinology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.

Abstract

Introduction: Diabetes mellitus in underrepresented racial and ethnic groups (URG) is rapidly increasing in incidence and has worse outcomes than diabetes in non-Hispanic White individuals. Rare and Atypical Diabetes Network (RADIANT) established recruitment targets based on the racial and ethnic distribution of the USA to enroll a diverse study population. We examined participation of URG across RADIANT study stages and described strategies to enhance recruitment and retention of URG.

Materials and methods: RADIANT is a multicenter NIH-funded study of people with uncharacterized forms of atypical diabetes. RADIANT participants consent online and progress through three sequential study stages, as eligible.

Results: We enrolled 601 participants with mean age 44 ± 16.8 years, 64.4% female. At Stage 1, 80.6% were White, 7.2% African American (AA), 12.2% other/more than one race, and 8.4% Hispanic. Enrollment of URG was significantly below preset targets across most stages. Referral sources differed by race (p < 0.001) but not ethnicity (p = 0.15). Most AA participants were referred by RADIANT investigators (58.5% vs. 24.5% in Whites), whereas flyers, news, social media, and family or friends were more frequent referral sources for White individuals (26.4% vs. 12.2% in AA). Ongoing initiatives to increase enrollment of URG in RADIANT include engaging with clinics/hospitals serving URG, screening electronic medical records, and providing culturally competent study coordination and targeted advertisement.

Conclusions: There is low participation of URG in RADIANT, potentially limiting the generalizability of its discoveries. Investigations into barriers and facilitators for recruitment and retention of URG in RADIANT, with implications for other studies, are ongoing.

Keywords: African American race; Race; clinical research; ethnicity; hispanic ethnicity.

Abstract

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