ABSTRACT
Background: Patient outcomes of COVID-19 have improved throughout the pandemic. However, because it is not known whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time, we investigated differences in COVID-19 outcomes for patients with T1D in the United States. Methods: We analyzed data collected via a registry of patients with T1D and COVID-19 from 56 sites between April 2020 and January 2021. We grouped cases into first surge (April 9, 2020, to July 31, 2020, n = 188) and late surge (August 1, 2020, to January 31, 2021, n = 410), and then compared outcomes between both groups using descriptive statistics and logistic regression models. Results: Adverse outcomes were more frequent during the first surge, including diabetic ketoacidosis (32% vs 15%, P< .001), severe hypoglycemia (4% vs 1%, P= .04), and hospitalization (52% vs 22%, P< .001). Patients in the first surge were older (28 [SD,18.8] years vs 18.0 [SD, 11.1] years, P< .001), had higher median hemoglobin A1c levels (9.3 [interquartile range {IQR}, 4.0] vs 8.4 (IQR, 2.8), P< .001), and were more likely to use public insurance (107 [57%] vs 154 [38%], P< .001). The odds of hospitalization for adults in the first surge were 5 times higher compared to the late surge (odds ratio, 5.01;95% CI, 2.11-12.63). Conclusion: Patients with T1D who presented with COVID-19 during the first surge had a higher proportion of adverse outcomes than those who presented in a later surge.
ABSTRACT
Introduction: The COVID-19 pandemic has had far-reaching consequences for individuals with type 1 diabetes (T1D) and has laid bare inequities in health care. Objectives: We sought to examine the United States (US) trends in diabetic ketoacidosis (DKA) across the lifespan during the COVID-19 pandemic and factors associated with these trends, compared to DKA rates the year prior to the pandemic. Methods: The T1D Exchange Quality Improvement Collaborative (T1DX-QI) collected aggregate data on the incidence of DKA among children and adults with established and new-onset T1D from 7 large medical centers in the US (total T1D population >15,000). We compared DKA rates during COVID-19 Wave 1 (March-May 2020) and COVID-19 Wave 2 (August-October 2020) to the same periods in 2019. Descriptive statistics were used to summarize data. Chi-square tests were used to compare differences in patient characteristics. Results: DKA rates were higher in patients with established T1D during COVID-19 Wave 1 compared to the same period in 2019 (6.15% vs 4.71%, p=<0.001). DKA rates were also higher in patients with established T1D during COVID-19 Wave 2 compared to 2019 (5.55% vs 4.90%, p=0.02). There were no differences in rates of DKA by age or DKA severity. DKA rates were lower among individuals on insulin pumps during both COVID-19 waves compared to 2019 (Wave 1: 6.43% vs 10.25%, p=0.008;Wave 2: 8.14% vs 11.21%, p=0.03). Consistent with known T1D inequities, DKA rates were exacerbated for NH Black patients in 2020, with 18% of NH Blacks with T1D experiencing DKA compared to 6% of NH Whites. Conclusions: DKA rates rose among patients with T1D during US COVID-19 Waves 1 and 2, with the highest rates among NH Blacks. These findings highlight the urgent need for improved strategies to decrease the risk of DKA in individuals with T1D under pandemic conditions, especially among populations most affected by health inequities.
ABSTRACT
Introduction: While there is rapidly emerging information describing race or ethnicity outcome disparities of patients hospitalized with COVID-19, no such data is available for people with type 1 diabetes (T1D). Objectives: This U.S. based, multi-center surveillance study aimed to investigate racial disparities among presenting symptoms, and adverse outcomes of patients with T1D who tested positive for SARS CoV-2 (N = 26) or are suspected to have COVID-19. As a secondary objective, this study also reports differences in access to SARS CoV-2 testing by racial group (Non-Hispanic White versus Minority) by analyzing data among T1D patients with COVID-like symptoms (N = 24) who were unable to get tested. Methods: De-identified patient data was collected through T1D Exchange's Type 1 Diabetes-COVID-19 Registry. Patient information for people who tested positive for SARS CoV-2, and patients suspected to have COVID-19 were reported by healthcare providers from U.S. Endocrinology clinics. Racial groups were classified as Non- Hispanic White (NH White) or minority (all other races). Results: We analyzed 50 patients with T1D, of which 25 (50%) were reported NH White, 10 (20.0%) Hispanic, 10 (20.0%) Non-Hispanic Black, 1 (2%) Asian, and 2 (4.0%) other. The mean age of the NH White population was 19.2 years (SD = 12.25, Range = 6.0-61.0), and 44% were female. Among the NH White population (N = 25), the reported highest level of care at the time of reporting was ICU at 16.6%, compared to 26.1% of the minority population (N = 23). Of the NH White population, 60% were tested for SARS CoV-2, compared to 36% of the minority population. The most prevalent adverse T1D outcome was diabetic ketoacidosis in both NH White (16.67%) and minority (34.78%) populations. Two patient deaths were recorded, one with confirmed COVID-19, both of Hispanic origin. Conclusions: This study provides racial differences in clinical outcomes of patients with T1D with confirmed or suspected COVID-19 in the United States.
ABSTRACT
Introduction: While there is rapidly emerging information describing characteristics of patients hospitalized with confirmed COVID-19, no such data is available for people with type 1 diabetes (T1D). Objective: This U.S. based, multi-center surveillance study aimed to investigate characteristics, presenting symptoms, and adverse outcomes of patients with T1D who tested positive for SARS CoV-2 (N = 26). As a secondary objective, this study also reports patient attributes and clinical outcomes among T1D patients with COVID-like symptoms (N = 24) who tested negative or were unable to get tested. Methods: De-identified patient data was collected through T1D Exchange's Type 1 Diabetes-COVID-19 Registry. Patient information for people who tested positive for SARS CoV-2, as well as patients suspected to have COVID-19 were reported by healthcare providers from Endocrinology clinics at participating sites in the US. Statistical analysis was completed using SAS Studio software (version 3.8). Results: We analyzed 50 patients with T1D, of which 26 tested positive for SARS CoV-2 by nasopharyngeal sample PCR, and 24 were reported to have COVID-19-like symptoms but no positive test. In the group that tested positive for SARS CoV-2 (N = 26), mean age was 25.5 years (SD = 17.98, range = 7.0-79.0, IQR = 14.0-28.0), 61.5% (16 of 26) were female, and 38.46% (10 of 26) were Non- Hispanic White. Among T1D patients who tested positive for SARS CoV-2, the most prevalent adverse type 1 diabetes outcome was diabetic ketoacidosis (42.3%). The highest level of care at the time of reporting was hospitalization (23.1% [6 of 26]) or ICU ((30.8% [8 of 26]) in this population. One patient with confirmed with COVID-19 and one patient with a suspected case (4.1%) died. Conclusions: This study provides patient characteristics and clinical outcomes of patients with type 1 diabetes who had either confirmed or suspected COVID-19 in the United States.