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Cited by 205Diabetes Management and ResearchDiabetes Management and EducationHealth disparities and outcomes

Racial-Ethnic Inequity in Young Adults With Type 1 Diabetes

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Agarwal, Shivani, Kanapka, Lauren G, Raymond, Jennifer K, Walker, Ashby, Gerard-Gonzalez, Andrea, Kruger, Davida, Redondo, Maria J, Rickels, Michael R +7 more·2020·The Journal of Clinical Endocrinology & Metabolism
DOI 10.1210/clinem/dgaa236PMC PMC7457963
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Abstract

Context: Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. Objective: To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES). Design: Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES. Setting: Six diabetes centers across the United States. Participants: A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic). Main Outcome: Racial-ethnic disparity in HbA1c levels. Results: Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black–White glycemic disparity. Conclusion: This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors.

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  • Inequitable use of diabetes technologies contributes at least in part to worse diabetes outcomes for socially disadvantaged groups with T1D.

    “Inequitable use of diabetes technologies contributes at least in part to worse diabetes outcomes for socially disadvantaged groups with T1D (e.g., racial or ethnic minority or lower socioeconomic status [SES]).”

    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 [24]

    The Discussion (page not provided) says lower diabetes technology use contributed to the remaining Black–White disparity in glycemic control after adjustment for socioeconomic status. The study concerns young adults, however, and does not establish the same contribution across all people with T1D or independently for lower-SES groups. (LLM, conf=0.84)

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  • Previous studies have demonstrated associations between income, insurance status and Race on use of diabetes technologies.

    “Although previous studies have demonstrated associations between income, insurance status and Race on use of diabetes technologies, 21 , 23 , 24 we are not aware of any previous studies applying an intersectional approach.”

    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 [24]

    The Results (Racial-ethnic comparisons; page unavailable) show substantially lower insulin-pump and CGM use among Black and Hispanic young adults than among White young adults, supporting the race-related association. The paper also reports differences in income and insurance by racial-ethnic group, but it does not establish separate associations of income or insurance status with technology use; the Discussion notes that technology-use disparities persisted despite device coverage. (LLM, conf=0.85)

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Research works printed but not linked: 41

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Authors
Agarwal, S., Kanapka, L. G., Raymond, J. K., Walker, A., Gerard-Gonzalez, A., Kruger, D., Redondo, M. J., Rickels, M. R., Shah, V. N., Butler, A., Gonzalez, J., Verdejo, A. S., Gal, R. L., Willi, S., & Long, J. A.
Affiliations
  • Albert Einstein College of Medicine (US)
  • Jaeb Center for Health Research (US)
  • Children's Hospital Los Angeles (US)
  • University of Florida (US)
  • Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
  • Henry Ford Health (US)
  • Baylor College of Medicine (US)
  • University of Pennsylvania (US)
  • University of Colorado Anschutz (US)
  • Children's Hospital of Philadelphia (US)
  • Philadelphia VA Medical Center (US)
Corresponding author
Agarwal, Shivani
ORCID
Venue
The Journal of Clinical Endocrinology & Metabolism
Publisher
The Endocrine Society
Published
2020-05-08
Volume
105
Issue
8
Pages
e2960-e2969
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
DOI
10.1210/clinem/dgaa236
PMC
PMC7457963
OpenAlex
W3021585007
Cited by
205
References
54
Citations by year
2026: 28 · 2025: 36 · 2024: 44 · 2023: 37 · 2022: 34 · 2021: 23 · 2020: 3
FWCI
18.29
Type
journal article
Language
en
Open access
Licence
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK115896-01A1)
  • NY-Regional Center for Diabetes Translational Research (5P30DK111022-03)
  • Leona M. and Harry B. Helmsley Charitable Trust
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Health › Health disparities and outcomes
Keywords
type 1 diabetes, young adults, racial and ethnic disparities, glycemic control, HbA1c, non-Hispanic blacks, Hispanic Americans, diabetes technology use, diabetes distress, disease self-management, social determinants of health, socioeconomic status
MeSH terms
Self-Management, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Ethnicity, Female, Glycated Hemoglobin, Humans, Male, Minority Groups, Patient Compliance, Social Class, United States, Blood Glucose Self-Monitoring, Racial Groups, Health Status Disparities, Young Adult, Social Determinants of Health

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