Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes in the Pediatric Diabetes Consortium (PDC)

Background: Type 2 diabetes in the United States is more prevalent in youth of minority racial-ethnic background but disparities in health outcomes have not be examined in this population.

Methods: We examined racial-ethnic differences in the initial presentation and subsequent comorbidities in youth with type 2 diabetes (N=1217, 63% females) enrolled in the Pediatric Diabetes Consortium (PDC) Registry from February 2012 to June 2018. Demographic and clinical data were collected from medical records and participant self-report.

Results: Overall, the mean age at presentation was 13.4 ± 2.4 years, BMI was 35.0 (9.4) kg/m². HbA1c was higher and C-peptide was lower in Non-Hispanic Black (NHB) and Hispanic (H) youth compared to Non-Hispanic White (NHW) youth. NHB were 3 times as likely to present in DKA (19%) vs. NHW (6.3%) and H (7.5%) and both NHB and H had a worse HbA1c trajectory compared with NHW peers. Microalbuminuria was documented in 11%, hypertension in 34% and dyslipidemia in 42% of Registry participants with no significant difference among racial-ethnic groups. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in 9% and 11% of H and NHW, respectively vs. 2% in NHB.

Conclusion: NHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA1c trajectories compared with NHW. Comorbidities exist in a large percentage of these youth independent of race-ethnicity, except for NAFLD being less prevalent in NHB. Greater efforts are needed to mitigate racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.