Inequalities in glycemic control in childhood onset type 2 diabetes in England and Wales—A national population‐based longitudinal study

Abstract

Background Not much is known about glycaemic‐control trajectories in childhood‐onset type 2 diabetes (T2D). We investigated characteristics of children and young people (CYP) with T2D and inequalities in glycemic control. Methods We studied 747 CYP with T2D, <19 years of age in 2009‐2016 (from the total population‐based National Pediatric Diabetes Audit [>95% diabetes cases in England/Wales]). Linear mixed‐effects modeling was used to assess socioeconomic and ethnic differences in longitudinal glycated hemoglobin (HbA1c) trajectories during 4 years post‐diagnosis (3326 HbA1c data points, mean 4.5 data points/subject). Self‐identified ethnicity was grouped into six categories. Index of Multiple Deprivation (a small geographical area‐level deprivation measure) was grouped into SES quintiles for analysis. Results Fifty‐eight percent were non‐White, 66% were female, and 41% were in the most disadvantaged SES quintile. Mean age and HbA1c at diagnosis were 13.4 years and 68 mmol/mol, respectively. Following an initial decrease between diagnosis and end of year 1 (−15.2 mmol/mol 95%CI, −19.2, −11.2), HbA1c trajectories increased between years 1 and 3 (10 mmol/mol, 7.6, 12.4), followed by slight gradual decrease subsequently (−1.6 mmol/mol, −2, −1.1). Compared to White CYP, Pakistani children had higher HbA1c at diagnosis (13.2 mmol/mol, 5.6‐20.9). During follow‐up, mixed‐ethnicity and Pakistani CYP had poorer glycemic control. Compared to children in the most disadvantaged quintile, those in the most advantaged had lower HbA1c at diagnosis (−6.3 mmol, −12.6, −0.1). Differences by SES remained during follow‐up. Mutual adjustment for SES and ethnicity did not substantially alter the above estimates. Conclusions About two‐thirds of children with childhood‐onset T2D were non‐White, female adolescents, just under half of whom live in the most disadvantaged areas of England and Wales. Additionally, there are substantial socioeconomic and ethnic inequalities in diabetes control.

Risk predictors of glycaemic control in children and adolescents with type 1 diabetes: A systematic review and meta‐analysis

“…Laura et al. (Khanolkar et al., 2019) conducted a study in 104 patients and found that family disorder was not conducive to HbA1c control in patients at 6‐month follow‐up (β = .46, p < .01). Good family support was beneficial for blood glucose control, and maternal affinity personality was beneficial for lowering HbA1c levels.…”

“…Laura et al (Khanolkar et al, 2019) conducted a study in 104 patients and found that family disorder was not conducive to HbA1c…”

ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents

“…Youth onset T2D disproportionately affects youth facing structural disadvantages, including living in poverty, 16,18,163,164,242 in food insecure households, and being a racialized minority. 243,244 In this context, mental health comorbidities including depression and anxiety are frequent among youth living with T2D.…”

The impact of race and socioeconomic factors on paediatric diabetes

“…There is an over representation of deprivation with 45% of cases drawn from the most deprived backgrounds ( Fig. 1 ), a number that has not changed over the last 4 years [ 18 , 44 ].

Fig.

…”