December 21, 2021

A recent article published online by the journal Diabetes Care aims to untangle racial and ethnic health disparities that affect youth and young adults with Type 1 diabetes.

Although there is evidence that youth and young adults of color living with diabetes are more likely to experience poorer health trajectories compared to their white counterparts, it remains unclear how differences in diabetes treatment regimens or technology use contribute to the inequity.

Researchers estimated the impact on population-level clinical outcomes of diabetes treatment if all youth of color with Type 1 diabetes in a large cohort of childhood diabetes had received an equitable distribution of diabetes treatment regimens compared with non-Hispanic white youth. The goal of the study was to provide new information to better understand opportunities for interventions to address health disparities.

The study, titled, “The Impact of Racial and Ethnic Health Disparities in Diabetes Management on Clinical Outcomes: A Reinforcement Learning Analysis of Health Inequity Among Youth and Young Adults in the SEARCH for Diabetes in Youth Study,” is the product of a four-year collaboration across two departments at the UNC Gillings School of Global Public Health and the UNC School of Nursing.

Dr. Anna Kahkoska

Dr. Anna Kahkoska

Dr. Elizabeth Mayer-Davis

Dr. Elizabeth Mayer-Davis

Anna Kahkoska, MD, PhD, assistant professor of nutrition, is co-lead author, alongside Teeranan Pokaprakarn, doctoral student in the Department of Biostatistics. Their co-authors include Elizabeth Mayer-Davis, PhD, Cary C. Boshamer Distinguished Professor of Nutrition and Medicine and chair of the Department of Nutrition,  W.R. Kenan, Jr. Distinguished Professor Michael Kosorok, PhD, in the Department of Biostatistics, and G. Rumay Alexander, EdD, RN, clinical professor in the UNC School of Nursing and former associate vice chancellor for diversity, equity and inclusion/chief diversity officer for the University.

Dr. Rumay Alexander

Dr. Rumay Alexander

Dr. Michael Kosorok

Dr. Michael Kosorok

“We used data from the United States-based SEARCH for Diabetes in Youth study and applied precision medicine statistical approaches to estimate outcomes — including glycemic control and the emergence of early diabetes complications — across racial and ethnic subpopulations, given the hypothetical receipt of different treatment regimens,” said Kahkoska. “We found that mathematically modeling an equitable distribution of Type 1 diabetes self-management tools and technology accounted for part, but not all, of the disparities in glycemic control between youth and young adults of color versus non-Hispanic white youth and young adults.”

These findings underscore the complexity of racial- and ethnic-based health inequity in diabetes care.

While the statistical methods the researchers used have previously been used to estimate treatment recommendations for individuals based on their characteristics and health status, this study provides an example of how the same methods can help to untangle complex patterns of health inequity for enhanced public health efforts.

“I believe this is the first analysis of its kind ever applied to answer these questions,” Kosorok said.

“This is precision medicine analytics applied to understand health inequities — a view of how data science can help us better identify the right actions to take for individuals and for populations,” added Mayer-Davis.

A key study finding was that simulating an equalized distribution of diabetes treatment and self-management regimens explained approximately 35% of the differences in hemoglobin A1c, a measure of average blood glucose levels, between the non-white and white subgroups at the population level.

The researchers aim to continue research to increase understanding of the role of diabetes treatment disparities among the many other drivers of health inequity in Type 1 diabetes — as well as actionable solutions.

“This study is just one piece of the puzzle,” Kahkoska said. “The reality is that it will take large, diverse teams of researchers, doctors and other care providers, community-based organizations, and the individuals and families who live with Type 1 diabetes, all working together, to tackle health inequities at scale.”


Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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