Background: Glycemic control (HbA1c) in teens with type 1 diabetes mellitus (T1DM) can be affected by several variables including race, insurance type, depression (PHQ-9 score), and diabetes distress (Paid-T score). This analysis sought to explore how these variables interact to affect HbA1c.

Methods: 301 patients with T1DM age 13 years and older were grouped by race (white = W, African American = AA, bi-racial = BR) and by insurance type (State Insurance = SI, or Private Insurance = PI). Mean HbA1c values were calculated according to race and insurance type. Analysis of Variance (ANOVA) testing was done to evaluate for any differences in HbA1c and race. Tukey’s Test was then performed to evaluate for a statistical difference between individual race variables (W, AA, BR).

Results: Mean HbA1c significantly varied by race (W 8.7 ± 0.1, AA 10.3 ± 0.5, BR 8.8 ± 0.5%, p<0.001 (mean ± SEM)). Tukey’s Test proved a statistically significant difference in HbA1c in AA compared with W (p<0.001) and in AA compared with BR (p=0.036), however there was not a significant difference in HbA1c in W compared with BR (p=0.976). HbA1c also differed in those with PI (8.3 ± 1.6) versus SI (9.7 ± 2.3), p<0.001 (mean ± SD). Diabetes distress scores (30.4 ± 16.3 in SI, 25.1 ± 13.2 in PI) and depression scores (4.6 ± 5.0 in SI, 2.3 ± 3.5 in PI) were greater in patients with SI versus PI, however there were no racial differences. ANOVA testing showed that there is no racial difference in depression score (p=0.284) or in distress score (p=0.201). When all factors were considered together, insurance status and distress score had the highest impact on HbA1c (p<0.001), depression score had a mild impact (p=0.02), and race was not significant (p=0.08).

Discussion: These results demonstrate that psychological factors such as diabetes distress and depression, and socioeconomic factors such as insurance status, have a bigger impact on HbA1c than race in teens with T1DM.

Disclosure

A. Guarneri: None. S.K. Sinha: None. K. Hong: None. R.P. Hoffman: Research Support; Spouse/Partner; Provention Bio, Inc.

© 2020 by the American Diabetes Association
2020
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