Race and Neighborhood-Related Disparities Spanning the COVID-19 Pandemic: Trajectories of Combined Glycemic Control and Body Mass Index in Youth with Diabetes

Objective: To use combined glycemic (HbA1c) and body mass index Z-score (BMIZ) trajectories spanning the COVID-19 pandemic to identify high-risk subgroups of adolescents with diabetes mellitus.

Research Design and Methods: Retrospective cohort of adolescents 10-19 years with type 1 and type 2 diabetes with ≥1 visits at a large pediatric hospital January 2018—March 2020 (pre-pandemic) and April 2020—August 2021 (pandemic). Group based trajectory models were used to identify latent classes of combined BMIZ and HbA1c trajectories. Multinomial logistic regression was used to evaluate predictors of class membership, including Area Deprivation Index (ADI) (socioeconomic status proxy). 

Results: The cohort included 1,322 youth with T1D (93% white, 7% Black) and 59 with T2D (53% Black, 47% white). For T1D, six trajectory classes emerged. Black youth were more likely to be in the class with worsening glycemic control and concurrent BMIZ decrease at pandemic onset (relative risk ratio [RRR] vs white: 3.0, 95% CI 1.3-6.8) or in the class with progressively worsening glycemic control and obesity (RRR 3.0, 95% CI 1.3-6.8), while those from the most deprived neighborhoods (RRR ADI tertile 3 vs 1: 1.9, 95% CI 1.2-2.9) were more likely to be in the class with stable obesity and glycemic control. For T2D, three distinct trajectories emerged, two of which experienced worsening glycemic control with concurrent BMIZ decline at pandemic onset. 

Conclusions: Race and neighborhood deprivation were independently associated with distinct glycemic and BMIZ trajectory classes in youth with diabetes, highlighting persistent and widening disparities associated with the COVID-19 pandemic.