Inequities in Diabetic Ketoacidosis Among Patients With Type 1 Diabetes and COVID-19: Data From 52 US Clinical Centers

Abstract

Objective We examined whether diabetic ketoacidosis (DKA), a serious complication of type 1 diabetes (T1D) was more prevalent among Non-Hispanic (NH) Black and Hispanic patients with T1D and laboratory-confirmed coronavirus disease 2019 (COVID-19) compared with NH Whites. Method This is a cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 52 clinical sites in the United States, data were collected from April to August 2020. We examined the distribution of patient factors and DKA events across NH White, NH Black, and Hispanic race/ethnicity groups. Multivariable logistic regression analysis was performed to examine the odds of DKA among NH Black and Hispanic patients with T1D as compared with NH White patients, adjusting for potential confounders, such as age, sex, insurance, and last glycated hemoglobin A1c (HbA1c) level. Results We included 180 patients with T1D and laboratory-confirmed COVID-19 in the analysis. Forty-four percent (n = 79) were NH White, 31% (n = 55) NH Black, 26% (n = 46) Hispanic. NH Blacks and Hispanics had higher median HbA1c than Whites (%-points [IQR]: 11.7 [4.7], P < 0.001, and 9.7 [3.1] vs 8.3 [2.4], P = 0.01, respectively). We found that more NH Black and Hispanic presented with DKA compared to Whites (55% and 33% vs 13%, P < 0.001 and P = 0.008, respectively). After adjusting for potential confounders, NH Black patients continued to have greater odds of presenting with DKA compared with NH Whites (OR [95% CI]: 3.7 [1.4, 10.6]). Conclusion We found that among T1D patients with COVID-19 infection, NH Black patients were more likely to present in DKA compared with NH White patients. Our findings demonstrate additional risk among NH Black patients with T1D and COVID-19.

Diabetes Technology Use for Management of Type 1 Diabetes Is Associated With Fewer Adverse COVID-19 Outcomes: Findings From the T1D Exchange COVID-19 Surveillance Registry

“…People with coronavirus disease 2019 (COVID-19) and preexisting type 1 diabetes (T1D) are at high risk of diabetesrelated outcomes such as diabetic ketoacidosis (DKA) and hospitalization (1). For people with elevated glucose levels, infections could further exacerbate the risk of acute complications.…”

“…We analyzed data from the T1DX COVID-19 Surveillance Registry, a U.S.based multicenter study for people with T1D, to examine the frequency of adverse outcomes across categories of technology use. The registry details have previously been described; briefly, all participating sites completed a chart review and via an online questionnaire submitted information on all patients with T1D at their sites who tested positive for COVID-19 (1,2). This analysis included 447 people with T1D and laboratory-confirmed COVID-19 infection during March 2020-December 2020.…”

Type 1 Diabetes Mellitus in the SARS-CoV-2 Pandemic: Oxidative Stress as a Major Pathophysiological Mechanism Linked to Adverse Clinical Outcomes

“…COVID-19 outcome severity in T1DM was related to poor glycemic control within the past year (HbA1c ~8%), the presence of chronic complications (hypertension, retinopathy, chronic kidney disease, neuropathy), older age, black ethnicity and low socioeconomic status [ 29 ]. (e) In a recent study, Ebekozien et al [ 30 ] investigated the prevalence of ketoacidosis among 180 non-Hispanic white, non-Hispanic black and Hispanic subjects with T1DM during COVID-19 infection in 52 clinical sites across the USA. The results showed that non-Hispanic blacks were more prone to develop ketoacidosis, suggesting the role of race and ethnicity.…”

“…In contrast to non-Hispanic blacks, most of the non-Hispanic white patients were using insulin pumps and continuous glucose monitoring systems (CGMS) in their treatment. (f) In contrast to these reports, Vangoitsenhoven et al [ 30 ] studied the hospitalization needs of 2336 subjects with T1DM from two diabetes specialist centers in the community during the first 3 months of the pandemic in Belgium. Of this cohort, only 0.21% were admitted to the hospital for treatment, suggesting that their risk for severe outcomes was not increased.…”

COVID-19 infection in type 1 diabetes: emerging data

“…In a cross-sectional study of subjects with type 1 diabetes and laboratory-confirmed COVID-19 from 52 clinical sites in the United States, Ebekozien et al [ 8 ] showed that the risk of diabetic ketoacidosis in black non-Hispanic patients is 3.7-fold higher than in white non-Hispanic patients.…”