Type 1 diabetes (T1D) affects a growing number of people around the world, including Canadians. Despite significant advances in the last decades in terms of technology and treatments, inequalities have been noted in the care and support received by people with T1D from certain racial and ethnic groups.
This is the finding made following certain studies based on the U.S. registry of people with T1D called T1D Exchange. Just like the BETTER registry in Canada, T1D Exchange invites people with T1D or parents of children with T1D to fill out one or several online questionnaires to better understand the reality of living with this condition.
Inequalities at different levels of care
The studies conducted using T1D Exchange data have shown gaps between different population groups at different levels, in particular:
- Prescription. People from certain racial and ethnic groups are less likely to get prescriptions for treatments such as new insulin types or glucagon, and for technologies such as CGMs or insulin pumps.
- Care. People from certain racial and ethnic groups are less likely to receive training on the use of new technologies.
- Health outcomes. People from certain racial and ethnic groups tend to have higher HbA1c levels or a higher risk of developing T1D-related complications in the short term (e.g., diabetic ketoacidosis) and long term (e.g., neuropathy, retinopathy, nephropathy).
Additional studies will be required to clarify the causes of these gaps and inequalities. There are probably many factors at play, including socioeconomic, cultural and linguistic factors, as well as implicit biases (unconscious preconceived beliefs about a group of people based on stereotypes or simplistic generalizations) among some healthcare professionals.
Greater diversity in research to address inequalities
Research plays a critical role in identifying and understanding the issues associated with T1D, and defining interventions to address inequalities and improve quality of care for everyone. These interventions can focus on people with T1D, as well as healthcare professionals, healthcare systems, communities and health policy.
However, the underrepresentation of certain marginalized groups in T1D research can contribute to maintaining inequalities. For this reason, efforts to improve diversity in future research projects are crucially needed.
Canada doesn’t have any data similar to the above for people with T1D, even though it’s an ethnoculturally diverse country, with over 200 ethnic origins having been declared in the 2011 census. It’s therefore critical for the BETTER registry to truly represent the T1D experience of all the different population groups in Canada.
We encourage people from visible minorities and Indigenous communities who are living with T1D or who have a child with T1D to fill out the questionnaires of the BETTER registry to raise awareness of their reality. By improving our representativeness, we’ll be able to improve our understanding of the illness and develop more effective individualized interventions for all groups affected by T1D in Canada.
- Bibliothèque du parlement, Les mots pour parler de race et d’ethnicité : une terminologie en évolution, consulté le 11 avril 2023, https://notesdelacolline.ca/2022/01/31/les-mots-pour-parler-de-race-et-dethnicite-une-terminologie-en-evolution/
- Black, Sandra A. “Diabetes, diversity, and disparity: what do we do with the evidence?.” American journal of public health vol. 92,4 (2002): 543-8. doi:10.2105/ajph.92.4.543
- Spanakis, Elias K, and Sherita Hill Golden. “Race/ethnic difference in diabetes and diabetic complications.” Current diabetes reports vol. 13,6 (2013): 814-23. doi:10.1007/s11892-013-0421-9
- T1D Exchange, Investigating Factors that Worsen Diabetes Care in the U.S., consulté le 11 avril 2023, https://t1dexchange.org/investigating-factors-that-worsen-diabetes-care-in-the-u-s/
- T1D Exchange, The Color of Your Skin Should Not Affect Your Diabetes Care, consulté le 11 avril 2023, https://t1dexchange.org/poc-diabetes-care/?utm_medium=social&utm_source=instagram&utm_campaign=article%3A+the+color+of+your+skin+should+not+affect+your+diabetes+care
Written by: Sarah Haag RN. BSc.
- Nathalie Kinnard, scientific writter and research assistant
- Rémi Rabasa-Lhoret, M.D., Ph.D.
Jacques Pelletier, Marie-Christine Payette, Claude Laforest, Sonia Fontaine, Aude Bandini, patient partners of the BETTER project
Linguistic revision by: Marie-Christine Payette