Ethnic differences in early glycemic control in childhood-onset type 1 diabetes

Khanolkar, Amal R, Amin, Rakesh, Taylor-Robinson, David ORCID: 0000-0002-5828-7724, Viner, Russell M, Warner, Justin, Gevers, Evelien F and Stephenson, Terence (2017) Ethnic differences in early glycemic control in childhood-onset type 1 diabetes BMJ OPEN DIABETES RESEARCH & CARE, 5 (1). e000423-. ISSN 2052-4897, 2052-4897

Text Early glycaemic control in T1D in East London_BMJ Open Diabetes Research_Khanolkar A et al 2017.pdf - Published version Download (688kB)

Abstract

Some ethnic minorities with type 1 diabetes (T1D) have worse glycemic control (higher glycated hemoglobin (HbA1<inf>c</inf>)) and increased risk for vascular complications. There is limited evidence on the impact of ethnicity on early glycemic control when most patients experience transient remission postdiagnosis. We examined associations between ethnicity and longitudinal HbA1<inf>c</inf>trajectories during the first 6 months postdiagnosis in a multiethnic cohort in East London. Research design and methods Data on 443 (50% female) children <19 years of age, with T1D and attending one of three clinics in East London between January 2005 and December 2015 were included. Linear mixedeffects modeling was used to assess ethnic differences in longitudinal HbA1<inf>c</inf>trajectories during the first 6 months postdiagnosis (1,028 HbA1<inf>c</inf>data points), adjusting for sex, age at diagnosis, socioeconomic status and pH at diagnosis. Growth curve modeling was used to plot discrete HbA1c trajectories by ethnicity. Results Longitudinal modeling revealed that all ethnic minorities had higher mean HbA1<inf>c</inf>at diagnosis compared with White children and highest in Bangladeshi (9.7 mmol/ mol, 95% CI 5.1 to 14.3), Asian-Other (5.8 mmol/mol, 95% CI 2.2 to 9.3) and Somali (5.2 mmol/mol, 95% CI 0.1 to 10.2) children, and these differences persisted over the 6-month period after diagnosis. During the first month, HbA1c decreased on average by 19.6 mmol/mol (95% CI −21 to −18) for all children. Population averaged HbA1<inf>c</inf>decreased between diagnosis and 4 months, followed by a gradual increase in HbA1<inf>c</inf>levels (mean difference of −30 mmol/mol between diagnosis and 6 months). Conclusions Ethnic minorities present with higher HbA1<inf>c</inf>at diagnosis, with the largest mean differences observed in Bangladeshi, Asian-Other and Somali children. These higher levels (indicating poorer glycemic control) track into the first 6 months postdiagnosis.

Item Type:	Article
Uncontrolled Keywords:	HbA1c, United Kingdom, diabetes mellitus, ethnicity, glycaemic control, inequalities, type 1
Depositing User:	Symplectic Admin
Date Deposited:	16 Aug 2017 06:42
Last Modified:	16 Jun 2026 05:26
DOI:	10.1136/bmjdrc-2017-000423
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3008989
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