Khanolkar, AR;
Amin, R;
Taylor-Robinson, D;
Viner, RM;
Warner, J;
Stephenson, T;
(2019)
Inequalities in glycaemic control in childhood onset type 2 diabetes in England and Wales - A national population-based longitudinal study.
Pediatric Diabetes
, 20
(7)
pp. 821-831.
10.1111/pedi.12897.
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Abstract
Background Not much is known about glycaemic-control trajectories in childhoodonset type 2 diabetes (T2D). We investigated characteristics of children and young people (CYP) with T2D and inequalities in glycaemic control. Methods We studied 747 CYP with T2D, <19 years old in 2009-2016 (from the total population-based National Paediatric Diabetes Audit [>95% diabetes cases in England/Wales]). Linear mixed-effects modelling was used to assess socioeconomic and ethnic differences in longitudinal glycated haemoglobin (HbA1c) trajectories during four years post-diagnosis (3,326 HbA1c datapoints, mean 4.5 datapoints/subject). Self-identified ethnicity was grouped into six categories. Index of Multiple Deprivation (a small geographical area-level deprivation measure) was grouped into SES quintiles for analysis. Results 58% were non-White, 66% were female and 41% were in the most disadvantaged SES quintile. Mean age and HbA1c at diagnosis were 13.4 years and 68mmol/mol respectively. Following an initial decrease between diagnosis and end of year 1 (-15.2mmol/mol 95%CI, -19.2, -11.2), HbA1c trajectories increased between years 1 and 3 (10mmol/mol, 7.6, 12.4), followed by slight gradual decrease subsequently (-1.6mmol/mol, -2, -1.1). Compared to White CYP, Pakistani children had higher HbA1c at diagnosis (13.2 mmol/mol, 5.6-20.9). During follow-up, mixed-ethnicity and Pakistani CYP had poorer glycaemic control. Compared to children in the most disadvantaged quintile, those in the most advantaged had lower HbA1c at diagnosis (-6.3mmol, -12.6, -0.1). Differences by SES remained during follow-up. Mutual adjustment for SES and ethnicity did not substantially alter the above estimates. Conclusions About two thirds of children with childhood-onset T2D were non-White, female adolescents, just under half of whom live in the most disadvantaged areas of England and Wales. Additionally, there are substantial socioeconomic and ethnic inequalities in diabetes control
| Type: | Article |
|---|---|
| Title: | Inequalities in glycaemic control in childhood onset type 2 diabetes in England and Wales - A national population-based longitudinal study |
| Location: | Denmark |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/pedi.12897 |
| Publisher version: | https://doi.org/10.1111/pedi.12897 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Diabetes Mellitus, Type 2; Glycated Hemoglobin A; Healthcare Disparities; Ethnic Groups; Socioeconomic Factors |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Population, Policy and Practice Dept |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10078742 |
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