Predictors of glycemic control in children with Type 1 diabetes - The importance of race

Diabetes is a common cause of kidney failure and blindness among young adul ts, particularly of African-American descent. Since glycemic control is a p redictor of diabetes complications, we evaluated the impact of multiple fac tors including a special multidisciplinary management program on glycosylat ed hemoglobin in children with Type 1 diabetes. Data was collected from ped iatric diabetes clinics in New Orleans, LA and Baltimore, MD. In New Orlean s, hemoglobin A(1c) was higher in African-American patients 12.5 +/- 3.3% ( n = 71) vs. 10.7 +/- 2.1% (n = 80) in Caucasian children, p < 0.0001. Longe r duration of diabetes was also associated with higher hemoglobin Al, in bo th races. The effect of race on hemoglobin A(1c) was independent of the inf luence of sex, insurance status, body mass index (BMI) z-score, and number of clinic visits. Covariate analysis with mean blood glucose levels indicat ed that higher hemoglobin A(1c) was attributable to higher mean blood gluco se levels in African-American children. From the Baltimore data, a multidis ciplinary intervention program led to improved total glycosylated hemoglobi n for Caucasian patients but not for African-American children. Poorer glyc emic control of African-American children is likely to predispose them to a higher likelihood of developing microvascular complications as they mature . Standard hospital-based multidisciplinary programming for diabetes manage ment may have limited effectiveness in improving glycemic control of Africa n-American children with diabetes. Innovative intervention programs are nee ded for these high-risk patients. (C) 2000 Elsevier Science Inc. All rights reserved.