TABLE 2.

Recommendations to Reduce Health Disparities Among Youths With Type 1 Diabetes

RecommendationRationale
Make preemptive efforts with at-risk families to maintain regular contact with households between office visits using text messaging or phone contact based on available resources to quickly ascertain issues of concern.Lower-income families in this study indicated that they rely more readily on kinship networks than on diabetes professionals in diabetes management and tend to be involved in few activities that connect them to health care providers. Lower-income youths are also hospitalized much more frequently for serious diabetes-related complications (5).
Do not rely on the Internet as the sole source of communication with at-risk families, and update contact information frequently.Research on computer use in the United States indicates that only 49% of households making ≤$25,000/year have access to the Internet (29). Phone outreach will be important. Also, the working poor tend to move more and change telephone numbers frequently given the constraints of poverty.
Consider cultural differences in parenting styles when assigning insulin regimens.Youths from lower-SES households are more likely to be unsupervised by adults and to have low levels of direct monitoring (8,9). In addition, for publically insured youths, access to supplies or technology may change as they transition into adulthood.
Recognize extracurricular involvement as a meaningful resource for coping with the challenges of diabetes.There are many documented benefits of engaging in extracurricular activities in childhood and adolescence. For youths with type 1 diabetes, such involvement increases social resourcing and provides an identity beyond their diagnosis, thus offsetting disease stigma (30).
Reduce barriers that keep lower-income families from gaining access to diabetes professional resourcing.Income constraints can create obstacles for having transportation to office visits, affording diabetes camps for children, or having access to online diabetes resources. Direct financial support in the form of transportation vouchers or scholarships, as well as incentives for keeping office visits, are invaluable.