Background: Previous studies identify non-White ethnicity as predictive of poor diabetes related outcomes. However, many of these reports originate from the United States and may, in part, reflect complex interactions between ethnicity, healthcare inequality and social deprivation.
Objective and hypotheses: We aimed to prospectively determine the effect of insulin intensification on glycaemic control and lipid levels in relation to ethnicity in a UK cohort of children and young persons (CYP) with type 1 diabetes (T1D).
Methods: Data were collected prospectively between 2008 and 2011 in CYP from a single paediatric diabetes centre (n=222; 40% White, 28% South Asian, 32% Black).
By 2009 nearly all CYP were treated with multiple daily injections or insulin pump therapy. Deprivation scores were derived from the UK 2010 Index of Multiple.
Deprivation. We used linear mixed level modelling to identify longitudinal differences between ethnic groups.
Results: At study end; Black CYP had higher HbA1c levels (9.4 (standard deviation 2.4) v South Asian 8.4 (1.9) v White 8.6 (1.7)%, P value for ANCOVA=0.007) but South Asians had lower HDL-cholesterol (1.4 (0.4) v White 2.0 (1.2) v Black 1.6 (0.4) mmol/l, P value=0.03) and higher triglyceride levels (1.8 (1.1) v 0.9 (0.4) v 1.0 (0.5) mmol/l, P value=0.001). In linear mixed models, after adjustment for socio-economic deprivation and other predictors; i) Black ethnicity associated with poorer glycaemic control (P<0.001) and ii) South Asian ethnicity associated with higher triglyceride levels (P<0.001), independent of HbA1c.
Conclusions: The effect of insulin intensification on glycaemic control and markers of future cardiovascular disease risk in CYP with T1D differs in relation to ethnic group. Ethnic specific thresholds for intervention should be considered during childhood.
07 - 09 Nov 2012
British Society for Paediatric Endocrinology and Diabetes