Equal access to health care may diminish the differences in outcome between native and immigrant patients with type 1 diabetes

TY - JOUR

T1 - Equal access to health care may diminish the differences in outcome between native and immigrant patients with type 1 diabetes

AU - Fredheim, Siri

AU - Delli, Ahmed

AU - Rida, Heba

AU - Drivvoll, Ann-Kristin

AU - Skrivarhaug, Torild

AU - Bjarnason, Ragnar

AU - Thorsson, Arni

AU - Lindblad, Bengt

AU - Svensson, Jannet

N1 - © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Background/Objective: Previous studies have found that ethnicity influences glycemic control. We hypothesized that differences between Nordic and non-Nordic patients are less pronounced for children with type 1 diabetes in high incidence countries in Northern Europe. Research design and methods: We investigated patients aged 0-15yr in national pediatric registers in Denmark (D), Iceland (I), Norway (N), and Sweden (S) (2006-2009). Ethnic origin was defined by maternal country of birth as being Nordic or non-Nordic (other countries). Results: The cohort (n=11,908, 53.0% boys, onset age 7.7 (3.9)yr, diabetes duration 6.1 (3.6)yr, [mean, (SD)]) comprised 921 (7.7%) non-Nordic patients. The frequencies of non-Nordic patients according to country of residence were: 5.7% (D), 2.7% (I), 5.5% (N), and 9.4% (S). Sex distribution and BMI z-score did not differ between Nordic and non-Nordic patients, but non-Nordic patients were 0.5 yr younger at onset than Nordic patients (p<0.0006). Non-Nordic patients had a lower number of daily insulin bolus injections and higher daily insulin doses compared to their Nordic peers. Patients of non-Nordic origin had slightly higher HbA1c levels (0.6-2.9mmol/mol, p<0.001) and, with the exception of Norway, were less frequently treated with CSII (p=0.002) after adjusting for confounders. Conclusions: The reported differences in glycemic regulation between Nordic and non-Nordic type 1 diabetes children and adolescents in four Nordic countries are diminutive, but persist after accounting for treatment intensity.

AB - Background/Objective: Previous studies have found that ethnicity influences glycemic control. We hypothesized that differences between Nordic and non-Nordic patients are less pronounced for children with type 1 diabetes in high incidence countries in Northern Europe. Research design and methods: We investigated patients aged 0-15yr in national pediatric registers in Denmark (D), Iceland (I), Norway (N), and Sweden (S) (2006-2009). Ethnic origin was defined by maternal country of birth as being Nordic or non-Nordic (other countries). Results: The cohort (n=11,908, 53.0% boys, onset age 7.7 (3.9)yr, diabetes duration 6.1 (3.6)yr, [mean, (SD)]) comprised 921 (7.7%) non-Nordic patients. The frequencies of non-Nordic patients according to country of residence were: 5.7% (D), 2.7% (I), 5.5% (N), and 9.4% (S). Sex distribution and BMI z-score did not differ between Nordic and non-Nordic patients, but non-Nordic patients were 0.5 yr younger at onset than Nordic patients (p<0.0006). Non-Nordic patients had a lower number of daily insulin bolus injections and higher daily insulin doses compared to their Nordic peers. Patients of non-Nordic origin had slightly higher HbA1c levels (0.6-2.9mmol/mol, p<0.001) and, with the exception of Norway, were less frequently treated with CSII (p=0.002) after adjusting for confounders. Conclusions: The reported differences in glycemic regulation between Nordic and non-Nordic type 1 diabetes children and adolescents in four Nordic countries are diminutive, but persist after accounting for treatment intensity.

U2 - 10.1111/pedi.12157

DO - 10.1111/pedi.12157

M3 - Journal article

C2 - 24909643

SN - 1399-543X

VL - 15

SP - 519

EP - 527

JO - Pediatric Diabetes

JF - Pediatric Diabetes

IS - 7

ER -