SEARCH for Diabetes in Youth has identified racial/ethnic disparities in patterns of glycemic control among T1D youth. How SEP and race/ethnicity intersect to influence these disparities is poorly ...understood. SEARCH T1D participants (n=1,313) age ≤20 years at diagnosis (dx) in 2002-5 were followed 6-13 years with 3+ hemoglobin A1c measures. Group-based trajectory modeling of A1c identified Group 1 (G1, 77%): lower A1c with mild increases (from mean 7.4 to 8.4%) and Group 2 (G2, 23%): high and increasing A1c (from 8.5 to 11.2%). Classification and regression tree analysis modeled patterns in 8 demographic and SEP attributes that distinguished between G2 and G1 (prediction accuracy 0.68). Race/ethnicity was most influential in predicting G2, with 39.6% G2 in minorities vs. 18.2% in non-Hispanic whites (NHWs) (Figure). Among minorities, 52.5% of those with public insurance were in G2 vs. 32.4% of those with private insurance. Among NHWs without college-educated parents, older age at dx (≥10 years) was associated with G2 (34.0% vs. 20.5% in dx <10 years). Among NHWs with college-educated parents, living in a 1-parent household was associated with G2 (23.6% vs. 8.9% in a 2-parent household). Race/ethnicity intersects differentially with select SEP attributes for NHW vs. minorities suggesting more nuanced studies of health disparities are needed.
Disclosure
A.D. Liese: None. B.A. Reboussin: None. A.R. Kahkoska: Other Relationship; Self; Novo Nordisk A/S. E.A. Frongillo: None. F. Malik: None. G. Imperatore: None. S. Saydah: None. A. Bellatorre: None. J.M. Lawrence: None. D. Dabelea: None. J.A. Mendoza: None.
Funding
National Institutes of Health (1R01DK117461, 1UC4DK108173)
Objective: To estimate change in prevalence of type 1 (T1D) and type 2 diabetes (T2D) among U.S. youth (<20 yrs.) from 2001 to 2017.
Methods: Diabetes cases prevalent in 2001, 2009 and 2017 were ...identified in geographic areas (Colorado, Ohio, South Carolina, Washington) and among managed health care members (California). Similar methods were used in each year. Prevalence (cases/1,000 youth) of physician-diagnosed T1D (0-19 years) and T2D (10-19 years) were calculated for each year. Population denominators were obtained from U.S. census data and membership counts. Race/ethnicity was categorized as non-Hispanic white (NHW), Hispanic (HSP), African American (AA), Asian/Pacific Islander (API) and American Indian (AI). Differences in proportions and annual percent change (APC) with 95% confidence intervals are reported.
Results: From 2001 to 2017, prevalence increased from 1.5 to 2.2/1,000 for T1D and from 0.3 to 0.7/1,000 for T2D (Table). Significant increases (p<0.05) in T1D and T2D were observed in each race/ethnicity group except T2D among AI (p=0.06). The greatest increases in T1D were among NHW and NHB and for T2D, among NHB, HSP, and API. APC was similar by sex within diabetes type.
Conclusions: While the prevalence of T1D is higher than youth-onset T2D, the APC is almost double for T2D. Efforts to identify and mitigate risk factors for onset of T1D and T2D remain vital public health priorities.
Disclosure
J.M. Lawrence: None. A.D. Liese: None. S. Saydah: None. G. Imperatore: None. E.T. Jensen: None. E.J. Mayer-Davis: None. D. Dabelea: None. D.J. Pettitt: None. S.M. Marcovina: None. C. Pihoker: None. L.M. Dolan: None. S. Isom: None. J. Divers: None.
Funding
Centers for Disease Control and Prevention; National Institute of Diabetes and Digestive and Kidney Diseases (1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139)
Objective
To examine the prevalence, time trends, and risk factors of diabetic retinopathy (DR) among youth with type 1 diabetes (T1D) from 11 countries (Australia, Austria, Denmark, England, ...Germany, Italy, Luxemburg, Netherlands, Slovenia, United States, and Wales).
Subjects and Methods
Data on individuals aged 10–21 years with T1D for >1 year during the period 2000–2020 were analyzed. We used a cross‐sectional design using the most recent year of visit to investigate the time trend. For datasets with longitudinal data, we aggregated the variables per participant and observational year, using data of the most recent year to take the longest observation period into account. DR screening was performed through quality assured national screening programs. Multiple logistic regression models adjusted for the year of the eye examination, age, gender, minority status, and duration of T1D were used to evaluate clinical characteristics and the risk of DR.
Results
Data from 156,090 individuals (47.1% female, median age 15.7 years, median duration of diabetes 5.2 years) were included. Overall, the unadjusted prevalence of any DR was 5.8%, varying from 0.0% (0/276) to 16.2% between countries. The probability of DR increased with longer disease duration (aORper‐1‐year‐increase = 1.04, 95% CI: 1.03–1.04, p < 0.0001), and decreased over time (aORper‐1‐year‐increase = 0.99, 95% CI: 0.98–1.00, p = 0.0093).
Evaluating possible modifiable risk factors in the exploratory analysis, the probability of DR increased with higher HbA1c (aORper‐1‐mmol/mol‐increase‐in‐HbA1c = 1.03, 95% CI: 1.03–1.03, p < 0.0001) and was higher among individuals with hypertension (aOR = 1.24, 95% CI: 1.11–1.38, p < 0.0001) and smokers (aOR = 1.30, 95% CI: 1.17–1.44, p < 0.0001).
Conclusions
The prevalence of DR in this large cohort of youth with T1D varied among countries, increased with diabetes duration, decreased over time, and was associated with higher HbA1c, hypertension, and smoking.
Objectives. To examine trends in the prevalence and disparities of traditional cardiovascular disease (CVD) risk factors among the major race/ethnic groups in the USA: non-Hispanic Whites (NHWs), ...non-Hispanic Blacks (NHBs), and Mexican Americans (MAs). Methods. We used cross-sectional trend analysis in women and men aged 25–84 years participating in the NHANES surveys, years 1988–1994 (n=14,341) and 1999–2004 (n=12,360). Results. The prevalence of obesity and hypertension increased significantly in NHW and NHB, both in men and women; NHB had the highest prevalence of obesity and hypertension in each time period. Diabetes prevalence showed a nonsignificant increasing trend in all groups and was higher in MA in both periods. Smoking significantly decreased in NHW men and NHB, the latter with the largest decline although the highest prevalence in each period; no changes were noted in MA, who had the lowest prevalence in both periods. Race/ethnic CVD risk factors disparities widened for obesity and hypercholesterolemia, remained unchanged for diabetes and hypertension, and narrowed for smoking. Conclusions. The increasing prevalence of obesity and hypertension underscores the need for better preventive measures, particularly in the NHB group that exhibits the worst trends. The decline in smoking rates may offset some of these unfavorable trends.
People with diabetes diagnosed before the age of 20 years have a life expectancy that is 15-27 years shorter than people without diabetes (1), although prospective data show improvements in mortality ...for those diagnosed in more recent years (2). ... only a decade ago, diabetes diagnosed in children and adolescents was almost entirely considered to be type 1 diabetes, most often due to the autoimmune destruction of the ß-cells of the pancreas leading to an absolute deficiency of insulin.
The intrauterine period is a critical time wherein developmental exposure can influence risk for chronic disease including childhood obesity. Using umbilical cord-derived mesenchymal stem cells ...(uMSC) from offspring born to normal-weight and obese mothers, we tested the hypothesis that changes in infant body composition over the first 5 months of life correspond with differences in cellular metabolism and transcriptomic profiles at birth. Higher long-chain acylcarnitine concentrations, lipid transport gene expression, and indicators of oxidative stress in uMSC-adipocytes were related to higher adiposity at 5 months of age. In uMSC-myocytes, lower amino acid concentrations and global differential gene expression for myocyte growth, amino acid biosynthesis, and oxidative stress were related to lower infant percent fat-free mass at 5 months of age, particularly in offspring of obese mothers. This is the first evidence of human infant adipocyte- or myocyte-related alterations in cellular metabolic pathways that correspond with increased adiposity and lower fat-free mass in early infancy. These pathways might reflect the effects of an adverse maternal metabolic environment on the fetal metabolome and genome. Our findings suggest that programmed differences in infant stem cell metabolism correspond with differences in body composition in early life, a known contributor to obesity risk.
Limited studies examine how prenatal environmental and social exposures jointly impact perinatal health. Here we investigated relationships between a neighborhood-level combined exposure (CE) index ...assessed during pregnancy and perinatal outcomes, including birthweight, gestational age, and preterm birth. Across all participants, higher CE index scores were associated with small decreases in birthweight and gestational age. We also observed effect modification by race; infants born to Black pregnant people had a greater risk of preterm birth for higher CE values compared to White infants. Overall, our results suggest that neighborhood social and environmental exposures have a small but measurable joint effect on neonatal indicators of health.
•We assessed combined exposure to environmental and social stressors in a national cohort.•Greater exposure was associated with lower birthweight and gestational age.•Greater exposure was associated with higher risk of preterm birth.•Exposure effects were modified by pregnant person race, educational attainment, and urbanicity.
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