Prescribed regimen intensity in diverse youth with type 1 diabetes: role of family and provider perceptions

Abstract

Recent literature suggests that disparities in prescribed treatments may exist for youth with type 1 diabetes. There is limited research to date examining factors associated with prescribed regimen intensity in this population. In this study, we examined racial/ethnic differences in regimen intensity and predictors of regimen intensity in youth with type 1 diabetes. We expected that minority youth would have less intensive regimens and that caregiver and physician perceptions would be associated with regimen intensity. This cross-sectional study included 178 families of 10- to 17-yr-old youth at three endocrinology clinics. Caregivers reported perceived costs and benefits of intensive regimens. Physicians described the prescribed treatment and their perceptions of family/child competence and self-management. Analyses included analysis of covariance and hierarchical multiple linear regression. Findings indicate a disparity in regimen intensity for minority youth. Caregiver perceptions of costs associated with intensive regimens and physician perceptions of family competence are associated with prescribed regimen intensity. Interventions targeting disparities in prescribed regimen intensity should be considered. Further research is needed to understand the role of family perceptions of treatments and physician clinical decision making in addressing health disparities in type 1 diabetes.

Caregiver reports of provider recommended frequency of blood glucose monitoring and actual testing frequency for youth with type 1 diabetes

“…While this study is not able to determine whether this is based on caregivers’ perceptions or actual provider behavior, this finding may support growing literature showing racial disparities in diabetes outcomes [20], and specifically corroborates reports indicating a disparity in regimen intensity for minority youth with type 1 diabetes [21]. In addition, those on an insulin pump were more likely to report more frequent monitoring.…”

ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes

“…It is a challenging task to educate and support effective self‐care among children and adolescents with diabetes and their caregivers, not least those with low economic and educational resources. Disparities in care and outcomes exist—less intensive treatments, poorer glucose control, and increased rates of DKA are reported in children from less advantaged homes as well as from countries with fewer resources …”

“…Disparities in care and outcomes exist-less intensive treatments, poorer glucose control, and increased rates of DKA are reported in children from less advantaged homes as well as from countries with fewer resources. [19][20][21][22][23][24] Health care staff should strive to determine each young person's and their caregiver's status regarding knowledge, perceived glycemic control, and risk perception, as well as perceived benefits and costs of health behaviors. The diabetes team is encouraged to engage with children as they mature, using developmentally appropriate educational tools, while recognizing that the child must be treated in the context of their existing psychosocial environment.…”

Racial-Ethnic Disparities in Management and Outcomes Among Children With Type 1 Diabetes

“…It remains controversial to what extent genetic, physiologic, 14 cultural, socioeconomic, 15 and providerrelated 13 factors underlie observed racial and ethnic disparities in treatment regimens and clinical outcomes. [16][17][18] Although some studies support the contention that socioeconomic status (SES) is more important than race as a predictor of glycemic control in pediatric populations, 10 the impact of SES has been difficult to establish due to the small number of high-income black and Hispanic families in the majority of these studies.…”