In Philadelphia, black children are disproportionately suffering from diabetes

In Philadelphia, the number of black children under age 5 diagnosed with type 1 diabetes has shot up 220% since the mid-1980s — and no one knows why.

It’s a finding that shocked the University of Pennsylvania researcher who has maintained a database of every child diagnosed with diabetes in the city dating back to 1985, since diagnosis at such a young age is unusual and dangerous. It also shocked me, as I sat in her University of Pennsylvania office, where I’d come to learn more about diabetes.

I’ve long been interested in how expensive it is to manage a chronic health condition and how costs spiral when the disease isn’t managed properly. I’m particularly interested in diabetes because it’s one of the most expensive chronic conditions — diabetics spend an average of $13,000 a year on health care — but also because it is so common in Philadelphia and, despite more education about the disease, people are getting sicker.

Last year, I wrote about a child who nearly went into a diabetic coma because his insurer had switched its preferred brand of insulin, and it wasn’t working well for him. But the plan insisted he at least try its preferred brand before paying for the one that had been keeping him stable for years.

As I talked to researchers, doctors and patients about diabetes, I quickly learned that one of the most troubling and urgent developments in the age-old diabetes story is its growing threat to children.

Even as new diagnoses decline among adults, diabetes is rising among children and is disproportionately affecting children of color. They are diagnosed at a growing rate compared to white children, receive less care, experience worse outcomes, more preventable hospitalizations and are more likely to die of the disease.

There are clear connections between type 2 diabetes, closely linked to obesity, and social determinants of health such as poverty, environment, access to healthy food and adequate physical activity.

But trauma, abuse and other adverse childhood experiences are increasingly recognized for their role in conditions such as obesity and diabetes. The director of a clinic in one of Philadelphia’s poorest minority neighborhoods told me her staff sees such links frequently.

The cause of type 1 diabetes, an autoimmune disease not connected to obesity, is unknown, but researchers suspect some of the same social determinants of health that contribute to type 2 may also trigger type 1.

The 24/7 routine of diabetes, especially type 1, can be unmanageable for families with working parents, limited incomes and other children with their own needs. Minority and low-income children are disproportionately affected by these stressors, too.

As one research paper put it, childhood diabetes is “a growing disease burden that will not be shared equally.”

Consider the following:

-  More kids have diabetes today, but fewer are dying of it overall. Yet black children still die from the disease at two times the rate as white children.

- Black children receive fewer routine diabetes tests compared to white children, putting them at higher risk of hospitalization. They are more likely than white children to be diagnosed through diabetic ketoacidosis, a serious and potentially deadly complication of diabetes when blood sugar is left unregulated for too long.

- Black children from families with annual incomes of $100,000 are less likely than white children from families earning half as much to be prescribed insulin pumps, which better regulate glucose levels and reduce hospitalizations.

These disparities are especially concerning in Philadelphia, which in addition to its diverse population, has the highest poverty rate of any big city in the nation, which is why my 2019 National Fellowship project will examine the intersection of childhood diabetes and social determinants of health.

I hope to work with local community leaders and patients to better understand the challenges Philadelphia families face managing a child’s diabetes, and explore ways to improve outcomes for the city’s children.

Photo by Katharine Mallon, via Flickr