Insulin pump use and blood sugar levels vary significantly between races
Type 1 diabetes treatment has evolved rapidly over the past few decades, but some racial and ethnic groups haven’t benefitted from these developments, according to a new study.
Researchers from the study, published in the journal Pediatrics, found black children with type 1 diabetes were less than half as likely to receive treatment with an insulin pump than white children. That difference persisted even when researchers adjusted the data to account for income, education and insurance. Hispanic children were also far less likely to be on an insulin pump. Black children were also found to have higher average blood sugar levels compared to other children. Higher blood sugar levels can indicate problems with blood sugar management.
“It’s been shown that insulin pump use is associated with [better blood sugar management],” said study co-author Kellee Miller, assistant director of the T1D Exchange Clinic Network Coordinating Center, and an epidemiologist at the Jaeb Center for Health Research in Tampa, Florida. “Our study is the first step in assessing what barriers exist to motivating someone to try newer technologies.”
Type 1 diabetes, an autoimmune disease that destroys the insulin-producing cells in the pancreas, requires insulin to help use the sugar from foods as fuel for the cells in the body and brain. People with type 1 diabetes produce little, or no, insulin of their own, so they need daily insulin shots, or they use an insulin pump. Though the pump eliminates the need for daily injections, the small tube that delivers insulin into the body must be changed every few days to prevent infections and scar tissue.
Getting the correct amount of insulin can be difficult. Type 1 diabetes sufferers must try to estimate how many carbohydrates are in their food, because carbohydrates are processed into sugar that’s released into the blood. The right amount of insulin helps that sugar get into cells. Too much insulin can cause dangerously low blood sugar levels. Too little allows blood sugar levels to rise, causing serious complications over time. Exercise and stress also affect insulin needs, making dosing a difficult balancing act.
The new study assessed nearly 11,000 children with type 1 diabetes from 73 endocrinology clinics across the country. A little more than 80 percent were white, 7 percent were black and 11 percent were Hispanic. Additionally, the group included 214 high-income black and Hispanic families. Researchers found that nearly two-thirds of white youngsters were on insulin pumps, while only 26 percent of the black children and slightly more than one-third of the Hispanic youngsters used the newer technology.
Cost is a factor in using an insulin pump to manage type 1 diabetes. The actual cost varies based on insurance plans, but a new pump can run more than $5,000. But the disparities in the study didn’t seem to be cost based.
Black children “were far less likely to be using pumps for insulin delivery, even after adjusting for socioeconomic status,” Miller said. “When we broke it down by annual household income, 45 percent of children in black families with more than $100,000 in household income were using an insulin pump. That was the same percentage [of children on pumps] in white families earning $50,000 or less.”
Researchers also found racial differences in the study participants’ hemoglobin A1c levels—a test that estimates average blood sugar levels over the past two or three months. The American Diabetes Association recommends that A1c levels in children be 7.5 percent or less. None of the groups in the study met that target. The average A1c for black children was 9.6 percent; for Hispanic children it was 8.7 percent, and in white children it was 8.4 percent.
Experts believe there may be a biological difference in how African-American patients respond to glucose. African Americans with type 2 diabetes and non-diabetic African Americans have higher A1c levels, leading researchers to surmise that there’s something independent of blood glucose that affects A1c in this population. This difference, called the “glycation gap,” could play a role in A1c differences, Miller said, but “I don’t think it explains the whole difference.”
Her team is now designing a study to better assess this difference. The study will monitor daily blood sugar levels over three months in blacks and whites to see how those levels compared to the A1c findings.