OBJECTIVE To use combined glycemic (HbA1c) and BMI z-score (BMIZ) trajectories spanning the coronavirus disease 2019 (COVID-19) pandemic to identify high-risk subgroups of adolescents with diabetes. RESEARCH DESIGN AND METHODS Retrospective cohort of adolescents 10–19 years old with type 1 and type 2 diabetes with one or more visits at a large pediatric hospital from January 2018 through February 2020 (prepandemic) and April 2020 through August 2021 (pandemic). Group-based trajectory models were used to identify latent classes of combined BMIZ and HbA1c trajectories. Multinomial logistic regression was used to evaluate predictors of class membership, including Area Deprivation Index (ADI) (socioeconomic status proxy). RESULTS The cohort included 1,322 youth with type 1 diabetes (93% White and 7% Black) and 59 with type 2 diabetes (53% Black and 47% White). For T1D, six trajectory classes emerged. Black youth were more likely to be in the class with worsening glycemic control and concurrent BMIZ decrease at pandemic onset (relative risk ratio [RRR] vs. White: 3.0 [95% CI 1.3–6.8]) or in the class with progressively worsening glycemic control and obesity (RRR 3.0 [95% CI 1.3–6.8]), while those from the most deprived neighborhoods (RRR ADI tertile 3 vs. 1: 1.9 [95% CI 1.2–2.9]) were more likely to be in the class with stable obesity and glycemic control. For type 2 diabetes, three distinct trajectories emerged, two of which experienced worsening glycemic control with concurrent BMIZ decline at pandemic onset. CONCLUSIONS Race and neighborhood deprivation were independently associated with distinct glycemic and BMIZ trajectory classes in youth with diabetes, highlighting persistent and widening disparities associated with the COVID-19 pandemic.
Objective: Youth-onset type 2 diabetes, most common among racial/ethnic minorities, threatens to widen health disparities due to severe complications in early adulthood and a 15-year reduction in life expectancy. Use of continuous glucose monitors (CGM) improves diabetes management in adults with type 2 diabetes, but socioeconomic and racial/ethnic disparities in diabetes technology use remain. We sought to examine factors impacting the acceptability of CGM use in adolescents and young adults (AYA) with type 2 diabetes. Methods: In this single center study, we conducted semi-structured interviews with AYA with type 2 diabetes and their parents to determine attitudes about CGM use, including barriers and facilitators. Interviews were audio-recorded, transcribed, and evaluated using thematic analysis. Results: Twenty AYA and 10 parents participated (n=30 total). AYA were mean age 16.5 years (SD 2.2, range 13.7-20.1) and had median diabetes duration of 1.3 years. Most were female (65%) and minority race/ethnicity (40% non-Hispanic Black; 10% Hispanic; 5% Asian). Seven (35%) used CGM. The primary benefit elicited was convenience over glucometer use. Important barriers included the impact of physically wearing the device and drawing unwanted attention, desire for AYA privacy, and adequate education about the device. Discussion: In this diverse sample of AYA with type 2 diabetes and their parents, CGMs were generally regarded as convenient, although concerns about worsening stigma and conflict with parents were prevalent. Our findings can guide the development of patient-centered approaches to CGM use for AYA with type 2 diabetes, a critical step toward reducing inequities in diabetes technology uptake. Disclosure V.Peyyety: None. M.Zupa: None. B.Hewitt: None. A.Rodriguez gonzalez: None. I.Mani: None. T.Prioleau: None. J.L.Mccurley: None. Y.Lin: None. M.Vajravelu: None. Funding Endocrine Fellows Foundation; National Institutes of Health (K23HL157763, K23DK129724, KL2TR001856, K23DK125719, UL1-TR-001857)
<p> </p> <p><u>Objective</u>: To use combined glycemic (HbA1c) and body mass index Z-score (BMIZ) trajectories spanning the COVID-19 pandemic to identify high-risk subgroups of adolescents with diabetes mellitus.</p> <p><u>Research Design and Methods</u>: Retrospective cohort of adolescents 10-19 years with type 1 and type 2 diabetes with ≥1 visits at a large pediatric hospital January 2018—March 2020 (pre-pandemic) and April 2020—August 2021 (pandemic). Group based trajectory models were used to identify latent classes of combined BMIZ and HbA1c trajectories. Multinomial logistic regression was used to evaluate predictors of class membership, including Area Deprivation Index (ADI) (socioeconomic status proxy). </p> <p><u>Results</u>: The cohort included 1,322 youth with T1D (93% white, 7% Black) and 59 with T2D (53% Black, 47% white). For T1D, six trajectory classes emerged. Black youth were more likely to be in the class with worsening glycemic control and concurrent BMIZ decrease at pandemic onset (relative risk ratio [RRR] vs white: 3.0, 95% CI 1.3-6.8) or in the class with progressively worsening glycemic control and obesity (RRR 3.0, 95% CI 1.3-6.8), while those from the most deprived neighborhoods (RRR ADI tertile 3 vs 1: 1.9, 95% CI 1.2-2.9) were more likely to be in the class with stable obesity and glycemic control. For T2D, three distinct trajectories emerged, two of which experienced worsening glycemic control with concurrent BMIZ decline at pandemic onset. </p> <p><u>Conclusions</u>: Race and neighborhood deprivation were independently associated with distinct glycemic and BMIZ trajectory classes in youth with diabetes, highlighting persistent and widening disparities associated with the COVID-19 pandemic.</p>
<p> </p> <p><u>Objective</u>: To use combined glycemic (HbA1c) and body mass index Z-score (BMIZ) trajectories spanning the COVID-19 pandemic to identify high-risk subgroups of adolescents with diabetes mellitus.</p> <p><u>Research Design and Methods</u>: Retrospective cohort of adolescents 10-19 years with type 1 and type 2 diabetes with ≥1 visits at a large pediatric hospital January 2018—March 2020 (pre-pandemic) and April 2020—August 2021 (pandemic). Group based trajectory models were used to identify latent classes of combined BMIZ and HbA1c trajectories. Multinomial logistic regression was used to evaluate predictors of class membership, including Area Deprivation Index (ADI) (socioeconomic status proxy). </p> <p><u>Results</u>: The cohort included 1,322 youth with T1D (93% white, 7% Black) and 59 with T2D (53% Black, 47% white). For T1D, six trajectory classes emerged. Black youth were more likely to be in the class with worsening glycemic control and concurrent BMIZ decrease at pandemic onset (relative risk ratio [RRR] vs white: 3.0, 95% CI 1.3-6.8) or in the class with progressively worsening glycemic control and obesity (RRR 3.0, 95% CI 1.3-6.8), while those from the most deprived neighborhoods (RRR ADI tertile 3 vs 1: 1.9, 95% CI 1.2-2.9) were more likely to be in the class with stable obesity and glycemic control. For T2D, three distinct trajectories emerged, two of which experienced worsening glycemic control with concurrent BMIZ decline at pandemic onset. </p> <p><u>Conclusions</u>: Race and neighborhood deprivation were independently associated with distinct glycemic and BMIZ trajectory classes in youth with diabetes, highlighting persistent and widening disparities associated with the COVID-19 pandemic.</p>
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