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Pediatric Diabetes ; 23(Supplement 31):48, 2022.
Article in English | EMBASE | ID: covidwho-2137177


Introduction: The use of continuous glucose monitors (CGM) and insulin pumps (PUMP) have been associated with improved outcomes in type 1 diabetes (T1D) care. Therefore, disengaging from these devices represents a risk for worsening health outcomes. Objective(s): We sought to evaluate the effect of the COVID-19 pandemic on device disengagement rates by race and ethnicity. Method(s): This retrospective cohort study Pre-COVID-19 [n = 15,838] + peri-COVID-19 ([n = 14,799]) used EMR data from 15 sites (i.e., 3 adult and 12 pediatric diabetes centers) within the T1D Exchange Quality Improvement Collaborative. We identified individuals using at least one Advanced Diabetes Technology (ADT [PUMP or CGM]) at their most recent visit. Individuals who continued to use that technology for at least two subsequent visits were classified as engaged. Those who reported not using ADT in two subsequent visits were classified as disengaged. Result(s): Comparing pre-COVID-19 (January 2017-March 2020) to peri-COVID-19 (April 2020-2021) time periods, we observed increases in disengagement among non-Hispanic White (NHW;42% to 45%, p = 0.03) and Hispanic (12% to 19%, p < 0.001) individuals. We found no difference among NH Black (NHB;61% to 62%, p = 0.7) individuals. Conclusion(s): The pandemic has presented self-care challenges for individuals with T1D, including continued use of ADT. NHB individuals exhibited the highest disengagement rates overall, while NHW/Hispanic individuals experienced significant pandemic-related increases in disengagement. Future research should evaluate the relative impact of intrinsic (i.e., patient-level) versus extrinsic (i.e., family-, environment-, and system-level) factors associated with race-/ethnicity- based differences in rate of disengagement.

Journal of Clinical Outcomes Management ; 29(5):185-192, 2022.
Article in English | EMBASE | ID: covidwho-2090913


There have been remarkable innovations in diabetes management since the start of the COVID-19 pandemic, but these groundbreaking innovations are drawing limited focus as the field focuses on the adverse impact of the pandemic on patients with diabetes. This article reviews select population health innovations in diabetes management that have become available over the past 2 years of the COVID-19 pandemic from the perspective of the T1D Exchange Quality Improvement Collaborative, a learning health network that focuses on improving care and outcomes for individuals with type 1 diabetes (T1D). Such innovations include expanded telemedicine access, collection of real-world data, machine learning and artificial intelligence, and new diabetes medications and devices. In addition, multiple innovative studies have been undertaken to explore contributors to health inequities in diabetes, and advocacy efforts for specific populations have been successful. Looking to the future, work is required to explore additional health equity successes that do not further exacerbate inequities and to look for additional innovative ways to engage people with T1D in their health care through conversations on social determinants of health and societal structures. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

Journal of Clinical Outcomes Management ; 29(1):27-31, 2022.
Article in English | EMBASE | ID: covidwho-1884742


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.

Pediatric Diabetes ; 22(SUPPL 30):35-36, 2021.
Article in English | EMBASE | ID: covidwho-1571032


Introduction: Health insurance coverage type differs significantly by socio-economic status and racial groups in the United States. There is limited data on the association between insurance and the risk of adverse outcomes for patients with pre-existing T1D and COVID19. Objectives: The aim of this study was to determine if publicly insured pediatric and adolescent patients with Type 1 Diabetes (T1D) were more likely to experience adverse outcomes compared to privately insured patients with acute COVID-19 infections. Methods: Data from 575 patients with previously established T1D aged <24 years with acute COVID-19 infections was analyzed from the T1DX-COVID-19 Surveillance Registry. Data for the registry was collected from 52 endocrinology clinics across the U.S, using an online survey tool. Each site completed the survey using electronic medical record (EMR) data between April 2020 and May 2021. Results: Privately insured patients were more likely to identify as Non-Hispanic White than publicly insured patients (63% vs 18%, p<0.001). T1D patients with COVID-19 that were on public insurance reported higher A1c (9.5% vs 7.9%, p<0.001), lower insulin pump use (29% vs 62%, p<0.001), as well as lower continuous glucose monitor (CGM) use (51% vs 77%, p<0.001) compared to privately insurance patients. Publicly insured patients with T1D and COVID-19 were three times more likely to be hospitalized than privately insured patients (Odds Ratio 3.4, 95% Confidence Interval: 2.1-5.4). Conclusions: Our data reveals a high rate of hospitalization and DKA among children and adolescents with T1D and COVID19 with public health insurance despite controlling for other potential confounders. This underscores that those on public health insurance are more vulnerable to adverse health outcomes during the COVID19 pandemic. (Table Presented).