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
Older adults with type 1 diabetes (OAwT1D) face challenges such as hypoglycemia, cognitive dysfunction, and physical limitations. Limited data on their technology use is available. We evaluated technology preferences in OAwT1D stratified by tech-savviness. Adults ≥ 65 years old (n=26) were enrolled at two sites during the COVID-19 pandemic. Subjects were stratified as tech-savvy or non-tech savvy based on the Pew Technology Survey. Health-related quality of life was assessed by the SF-36 Survey. Semi-structured telephone interviews were conducted (n=23) and analyzed for thematic content using ATLAS.ti v8.0. Individuals were all well-educated;those in the tech-savvy group were younger, more likely to be employed, and reported better physical functioning (Table 1). Per interview data, all subjects used a computer, smartphone, or the internet;the non-savvy group relied more on others to help download information or navigate content. Subjects preferred in-person training, menu systems with data access in 3 steps, flexibility of data access and entry, and/or a help menu. For device management, 6/23 subjects downloaded their data to share with care teams and 14/23 subjects cited healthcare providers as their primary tech support. OAwT1D have unique preferences for technology use and training. Customized training for device use and patient support should be considered to maximize device benefits in this high-risk group.