Exploring Racial/Ethnic Disparities in Arterial Stiffness in Youth with Type 1 Diabetes

Katherine Sauder, PhD, provides perspective on an ADA 2022 study she led examining racial/ethnic disparities in arterial stiffness among youths with type 1 diabetes in the US.

Using data from the SEARCH for Diabetes in Youth study, new research presented at the American Diabetes Association 82nd Scientific Sessions details racial and ethnic disparities in arterial stiffness among patients with type 1 diabetes in the US.

Presented by Katherine Sauder, PhD, of the University of Colorado, results of the study suggest racial and ethnic disparities in arterial stiffness are a driver of the cardiovascular risk factors among patients with type 1 diabetes.

"Cardiovascular disease is very common in people with diabetes. And when you have youth onset diabetes, those risks start to increase very early in life. It's not in the 50s and 60s and 70s. But it's much earlier in life. So, we found in the SEARCH for Diabetes in Youth study that we do start to see cardiovascular comorbidities in the early 20s,” said Sauder in an interview with Endocrinology Network. “So just 8-10 years after a type 1 diabetes diagnosis, this starts to appear. But it doesn't appear in everybody equally, we found that arterial stiffness, which is a measure of cardiac health was actually more prevalent in non-Hispanic black youth and young adults compared to non-Hispanic whites, and also more common in Hispanics compared to non-Hispanic whites.”

The SEARCH for Diabetes in Youth study followed pediatric patients with diabetes from 10 months up to 11 years after diagnosis at 5 clinical sites in the US. In total, the study collected data related to 1162 participants with type 1 diabetes who had data collected at 3 visits that took place approximately 5 years apart and assessed 6 specific domains, including socioeconomic factors, type 1 diabetes characteristics, cardiovascular risk factors, health behaviors, quality of care, and perception of care. Of note, arterial stiffness was assessed via carotid-femoral pulse wave velocity at 20 years of age.

Of the 1162 participants, 254 identified as Hispanic, 208 identified as non-Hispanic Black, 700 identified as non-Hispanic White. For the purpose of analysis, investigators used generalized linear models to estimate differences in pulse wave velocity (PWV) by race and ethnicity, with adjustment for sex, age at measurement, and SEARCH study center. For each risk factor, investigators assessed the longitudinal data as mean, max, slope, and area-under-the-curve (AUC).

Upon analysis, results indicate racial and ethnic disparities in arterial stiffness were partially explained differences in socioeconomic status and cardiovascular risk factors. Specifically, these factors attenuated the disparity in arterial stiffness seen among Hispanic and non-Hispanic White patients by 21% (P >.005), the disparity observed between non-Hispanic Black and Hispanic patients by 35% (P >.005), and the disparity observed between non-Hispanic Black and non-Hispanic White patients by 30% (P <.05).

“It's partly explained by the traditional cardiovascular risk factors, but only about a third of it. So, two-thirds of what is driving these disparities in cardiovascular disease and type 1 diabetes doesn't appear to be our typical biological factors. That means there are other things that are involved. We found that socioeconomic position was also involved, the household income, the kind of insurance, even access to care. When we ask participants about whether they have missed medications in the prior year because of cost and that, specifically, was linked to these disparities in cardiovascular disease,” Sauder added. “So again, it's not just the straight biological, clinical risk factors that we need to be attending to, but the broader picture, the social determinants of health, all of the things about our lives about these kids’ lives that impact their health long term.”

This study, “Exploring Racial and Ethnic Disparities in Arterial Stiffness in Type 1 Diabetes,” was presented at ADA 2022.