ABSTRACT
Introduction: We know that nutritional education and goal BMI are important to all diabetes management. Objective(s): Aim was to see how HbA1c and BMI were affected pre- and post- COVID-19 pandemic in youth with established type 1 (T1D), type 2 (T2D) and those followed in youth diabetes prevention clinic (YDPC). Method(s): Retrospective chart review. Youth included if diagnosed with diabetes prior to 4/2/2019, seen the year pre-COVID (between 4/2/2019-3/22/2020) (or for YDPC clinic just seen in that year prior), who also had 1 follow-up (f/u) visit after the start of the pandemic (3/23/2020-12/31/2020). The second f/u interval was 8/1/2021- 12/31/2021. The statistical analysis was conducted using GraphPad Prism Version 8. For continuous variables, the D'Agostino and Pearson test was used to determine normality, and data were compared using a paired t-test or a Wilcoxon matched-pairs signed-rank test depending on variable type. Result(s): There was no change in HbA1c or BMI z-score pre-COVID pandemic versus first f/u visit in the YDPC or T1D group (see Table). However, in the T2D group, there was a statistical increase in HbA1c at first f/u (p = 0.003), with no change in BMI z-score. In the second f/u interval (n = 166/277 T1D group, n = 15/34 T2D group), there was no change in HbA1C, but there was a statistical decrease in BMI z-score (p-value of 0.03) in the T1D group. Conclusion(s): Of our 3 cohorts, it appears that the youth with established T2D had a significant increase in HbA1c at first follow-up after the COVID-19 pandemic, with no significant change in BMI z-score. Thus, this change in HbA1c appears related to other factors. Youth with established T1D did not have a change in HbA1c or BMI z-score. However, in the subset of patients that were seen during the second f/u interval, their BMI z-score did seem to increase. This potentially reflects the national trend of increased obesity in healthy children. Even in those with T1D, these trends in BMI are important to help guide improved outcomes.
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.