Race and Neighborhood SES Differences in the Development Trajectories of Type 1 Diabetes Management of Caucasian and Ethnic Minority Youth
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Pediatric diabetes is a chronic illness that significantly impacts the lives of children and adolescents and their families. Poor metabolic control increases the risks for severe long-term consequences with debilitating effects in adulthood. Adolescence is a particularly difficult period of time for Caucasian youth as they evidence characteristic declines in metabolic control. There is some cross-sectional evidence that racial disparities in pediatric diabetes exist. However, only one study has evaluated racial disparities longitudinally and no studies have evaluated these differences across the critical period of adolescence. The aims of this retrospective study were to replicate age-related declines in metabolic control in a sample of African American youth and to characterize racial differences in the developmental trajectories of metabolic control between African American and Caucasian youth. This study also aimed to evaluate whether race effects remained beyond neighborhood SES. The sample consisted of 162 Caucasian and African American subjects matched on gender and age seen at the Children's Medical Center Dallas endocrinology outpatient clinic during 2007. Retrospective medical record reviews were conducted for sociodemographic information and retrospective health data. Neighborhood SES variables were obtained through publicly available census databases. This retrospective investigation revealed age-related declines in metabolic control regardless of race. African American youth had higher HbA1c levels compared to Caucasian counterparts throughout ages 10 through 18. However, African American and Caucasian youth evidenced parallel trajectories (similar rates of change) in metabolic control across this critical period. Race retained unique explanatory effects beyond that of neighborhood SES while family structure was not a predictive variable. These results suggest that African American youth experience significant risks prior to adolescence that place them at poorer levels of metabolic control and these risks are maintained across adolescence. Adolescence may be an equally risky period for African American and Caucasian youth, highlighting the need for further research on how African American youth and their families cope with diabetes. These results provide evidence that adolescence may be a critical period for both African American and Caucasian youth and unique interventions should be developed to prevent declines in metabolic control during adolescence in both racial groups.