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
Problem-based instruction is an active learning instructional practice that requires students to use rational and critical thinking skills to generate reasonable solutions to problem-based scenarios. For complex medical conditions such as stroke, degenerative diseases, and traumatic brain injury, students must have a strong command of neuroanatomy and physiology. While virtual and synthetic dissection simulation tools alleviate the need for procuring and maintaining costly resources, like cadavers, these tools are costly, inaccessible to students online, and inadequate in the teaching of practical knowledge needed to solve real-life clinical problems. In the wake of the Covid-19 pandemic, many courses have switched to an online format surprising students and faculty. The web-based visualization repository presented is intended to provide medical students with a comprehensive, web-based visual and problem-based learning tool to assist their learning of anatomical and neurophysiological concepts as applied to various medical disorders. The application can be used for online learning, as well as for in-person learning. © 2021 ACM.