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Cited by 42Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

Young people with Type 1 diabetes of non‐white ethnicity and lower socio‐economic status have poorer glycaemic control in England and Wales

Open access
Khanolkar, A. R., Amin, R., Taylor‐Robinson, D., Viner, R. M., Warner, J. T., Stephenson, T.·2016·Diabetic Medicine
DOI 10.1111/dme.13079
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Abstract

Background: The impact of ethnicity and socio‐economic status (SES) on glycaemic control during childhood Type 1 diabetes is poorly understood in England and Wales. Methods: We studied 18 478 children with Type 1 diabetes (< 19 years) attending diabetes clinics and included in the 2012–2013 National Paediatric Diabetes Audit. Self‐identified ethnicity was categorized as white, Asian, black, mixed, other and ‘not‐stated’ (did not to divulge ethnicity). A small area measure of SES was estimated from the Index of Multiple Deprivation. Multiple linear regression was used to assess associations between ethnicity, SES and glycaemic control (mean HbA 1c levels) accounting for age, gender and diabetes duration. The impact of insulin pump use on the ethnicity/SES–HbA 1c associations was tested in 13 962 children. Results: All children from minority ethnic groups had higher mean HbA 1c compared with white children, with largest differences observed in black and mixed ethnicities [8 mmol/mol (2.9%), 95% CI 5–11 and 7 mmol/mol (2.8%), 95% CI 5–9, respectively]. Lower SES was associated with higher mean HbA 1c with a dose effect. The lowest SES group had a mean HbA 1c that was 7 mmol/mol (2.8%) (95% CI 6–8) higher compared with the highest SES group, adjusted for ethnicity. Estimates for ethnicity were attenuated, but significant on adjustment for SES. Fewer non‐white (white 20.3 vs. black 5.5%) and deprived (least deprived 21.1 vs. most deprived 13.2%) children were on insulin pump therapy. Ethnicity and SES remained significant predictors of HbA 1c after accounting for insulin pump use. Conclusion: The association between ethnicity and glycaemic control persists after adjustment for deprivation and pump use. An alternative approach to intensive insulin therapy might benefit these vulnerable children.

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  • Disparities in diabetes technology use persist despite the availability of insurance or public funding.

    “Although financial costs are a major barrier to accessing diabetes technologies, disparities persist despite the availability of insurance or public funding.”

    From Social disadvantage and technology use among adults with type 1 diabetes in Quebec: A cross‐sectional study using data from the Canadian <scp>T1D</scp> ( <scp>BETTER</scp> ) Registry (2025) · cites this paper as [25]

    The available Introduction reports ethnic and socioeconomic disparities in glycaemic control, not diabetes technology use. Searches for insulin pumps, technology access, insurance, and public funding found no passage establishing that technology-use disparities persist despite coverage. The indexed text is also headed as a different paper that cites the named source, so it cannot verify this attribution. (LLM, conf=0.76)

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Research works printed but not linked: 4

  1. Mallare JT, Cordice CC, Ryan BA, Carey DE, Kreitzer PM, Frank GR. Identifying risk factors for the development of diabetic ketoacidosis in new onset type 1 diabetes mellitus. Clin Pediatr (Phila). 2003;42(7):591-7.
  2. Komulainen J, Lounamaa R, Knip M, et al. Ketoacidosis at the diagnosis of type 1 (insulin dependent) diabetes mellitus is related to poor residual beta cell function. Arch Dis Child. 1996;75(5):410-5.
  3. Hochhauser CJ, Rapaport R, Shemesh E, Schmeidler J, Chemtob CM. Age at diagnosis, gender, and metabolic control in children with type 1 diabetes. Pediatric Diabetes. 2008;9(4):303-7. doi:10.1111/j.1399- 5448.2008.00395.x · DOI
  4. R.S. B. Ethnicity, race, and health in multicultural societies: Oxford University Press; 2007.

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Authors
Khanolkar, A. R., Amin, R., Taylor‐Robinson, D., Viner, R. M., Warner, J. T., & Stephenson, T.
Affiliations
  • Karolinska Institutet (SE)
  • University College London (GB)
  • Institute of Child Health University College London (UCL) London UK
  • University Hospital of Wales (GB)
Corresponding author
Khanolkar, A. R.
ORCID
Venue
Diabetic Medicine
Publisher
Wiley
Published
2016-02-23
Volume
33
Issue
11
Pages
1508-1515
ISSN
  • 0742-3071 (ISSN-L)
  • 1464-5491
DOI
10.1111/dme.13079
OpenAlex
W2260827737
Cited by
42
References
28
Citations by year
2026: 4 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 5 · 2021: 3 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 3 · 2016: 3
FWCI
5.36
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Diabetic Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • National Institute for Health Research
  • Great Ormond Street Hospital for Children
  • University College London
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
type 1 diabetes, children, glycemic control, HbA1c, ethnicity, socioeconomic status, deprivation, insulin pump therapy, intensive insulin therapy, ethnic disparities, pediatric diabetes
MeSH terms
Adolescent, Blood Glucose, Child, Child, Preschool, Diabetes Mellitus, Type 1, England, Ethnicity, Female, Glycated Hemoglobin, Humans, Infant, Male, Minority Groups, Social Class, Wales, Young Adult

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