Racial differences in neighborhood disadvantage, inflammation and metabolic control in black and white pediatric type 1 diabetes patients.
Racial differences in neighborhood disadvantage, inflammation and metabolic control in black and white pediatric type 1 diabetes patients.
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DOI：
10.1111/pedi.12361
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发表时间：
2017-03
影响因子：
3.4
通讯作者：
Hempe JM
中科院分区：
文献类型：
--
作者：
Coulon SJ;Velasco-Gonzalez C;Scribner R;Park CL;Gomez R;Vargas A;Stender S;Zabaleta J;Clesi P;Chalew SA;Hempe JM
在种族混合人群中，血糖和血红蛋白A1c （HbA1c）之间关系的种族差异使糖尿病的诊断和管理复杂化。了解黑人HbA1c持续高于白人的原因，有助于减少糖尿病结局的种族差异。在一个种族混合的儿童1型糖尿病患者群体中，检验邻里不利与炎症和代谢控制不良有关的假设。从糖尿病诊所招募患者（n = 86, 53名白人，33名黑人）。从患者血糖仪下载自我监测的平均血糖（MBG）。采集血液进行糖化血红蛋白（HbA1c）和c反应蛋白（CRP）分析。采用患者地址和人口普查数据计算集中劣势指数（CDI）。高CDI反映了弱势社区的特点。黑人HbA1c和MBG [10.4% (90.3 mmol/mol)， 255 mg/dL]高于白人[8.9% (73.9 mmol/mol), 198 mg/dL] （p < 0.0001）。CDI在黑人中较高（p < 0.0001），与HbA1c （r = 0.40, p = 0.0002）和MBG （r = 0.35, p = 0.0011）呈正相关（除非种族控制）。种族间线性回归显示CDI与CRP呈正相关。CRP在种族间无差异，与MBG无相关性，但在控制种族后与HbA1c呈正相关（p = 0.04）。儿童1型糖尿病患者的邻里不利与炎症和代谢控制不良有关。潜在的混杂因素中明显的种族差异排除了遗传和环境影响之间的差异。未来的研究应招募符合社区特征和治疗方案的患者，以更全面地评估HbA1c的种族差异。
Racial variation in the relationship between blood glucose and hemoglobin A1c (HbA1c) complicates diabetes diagnosis and management in racially mixed populations. Understanding why HbA1c is persistently higher in blacks than whites could help reduce racial disparity in diabetes outcomes. Test the hypothesis that neighborhood disadvantage is associated with inflammation and poor metabolic control in a racially mixed population of pediatric type 1 diabetes patients. Patients (n = 86, 53 white, 33 black) were recruited from diabetes clinics. Self-monitored mean blood glucose (MBG) was downloaded from patient glucose meters. Blood was collected for analysis of HbA1c and C-reactive protein (CRP). Patient addresses and census data were used to calculate a concentrated disadvantage index (CDI). High CDI reflects characteristics of disadvantaged neighborhoods. HbA1c and MBG were higher (p < 0.0001) in blacks [10.4% (90.3 mmol/mol), 255 mg/dL] than whites [8.9% (73.9 mmol/mol), 198 mg/dL). CDI was higher in blacks (p < 0.0001) and positively correlated with HbA1c (r = 0.40, p = 0.0002) and MBG (r = 0.35, p = 0.0011) unless controlled for race. CDI was positively associated with CRP by linear regression within racial groups. CRP was not different between racial groups, and was not correlated with MBG, but was positively correlated with HbA1c when controlled for race (p = 0.04). Neighborhood disadvantage was associated with inflammation and poor metabolic control in pediatric type 1 diabetes patients. Marked racial differences in potential confounding factors precluded differentiation between genetic and environmental effects. Future studies should recruit patients matched for neighborhood characteristics and treatment regimen to more comprehensively assess racial variation in HbA1c.