Diabetes distress and HbA1c in racially/ethnically and socioeconomically diverse youth with type 1 diabetes

Pediatr Diabetes. 2020 Nov;21(7):1362-1369. doi: 10.1111/pedi.13108. Epub 2020 Sep 7.


Background: Diabetes distress, the emotional burden of caring for the chronic demands of diabetes, has not been well described in children and preadolescents with type 1 diabetes (T1D). This gap is particularly evident among youth of lower socioeconomic status (SES) and/or racial/ethnic minorities. Since these groups are more likely to have disparities in health outcomes and healthcare related to their diabetes, factors that could potentially improve glycemic and other diabetes-related outcomes should be studied closely.

Objective: We hypothesized that (a) diabetes distress levels would be elevated in children with markers of lower SES and those of racial/ethnic minorities, and (b) higher HbA1c would be predicted by higher diabetes distress levels, when controlling for race/ethnicity, SES, and clinical covariates.

Methods: One hundred and eighty-seven youth age 9 to 13 with T1D completed age-appropriate Problem Areas in Diabetes (PAID) questionnaires using a web-based portal during routine diabetes care visits.

Results: PAID scores were significantly elevated in youth who had surrogate markers of lower SES and who were from racial/ethnic minority backgrounds. In multivariate models including race/ethnicity or the SES variables and controlling for clinical covariates, the factor most predictive of higher HbA1c was elevated PAID score.

Conclusions: Diabetes distress is elevated in a younger population of children with T1D who are from racial/ethnic minority backgrounds or have markers of lower SES. Interventions that target distress and/or expand the safety net in these populations could potentially improve glycemic outcomes.

Keywords: adolescent; child; diabetes mellitus, type 1; minority; psychological factors; socioeconomic status.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Black or African American / psychology*
  • Child
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / ethnology
  • Diabetes Mellitus, Type 1 / psychology
  • Female
  • Glycated Hemoglobin / metabolism*
  • Hispanic or Latino / psychology*
  • Humans
  • Male
  • Psychological Distress*
  • Socioeconomic Factors*
  • Surveys and Questionnaires


  • Glycated Hemoglobin A