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Dr. Osagie Ebekozien (Vice President of Quality Improvement & Population Health, T1D Exchange) presented alarming evidence showing a strong association between diabetic ketoacidosis (DKA) and COVID-19, with non-Hispanic Black and Hispanic populations at the greatest risk. As part of the T1D Exchange Quality Improvement Collaborative, Dr. Ebekozien led a multi-center health surveillance program to assess the clinical outcomes, demographics, and epidemiology of type 1 diabetes patients who became ill with COVID-19. Between April and September 2020, this program tracked over 300 laboratory-confirmed and over 150 suspected COVID-19 cases in type 1 patients. For each case, HCPs in 52 participating centers across 23 states completed 33-question surveys to gather non-identifiable patient data. Of importance, a striking 67% of laboratory-confirmed COVID-19 cases in type 1 diabetes patients were in patients ages 0-24 years, while the remaining 33% were 25 years or older. Dr. Ebekozien elaborated on this younger and more heavily affected subgroup in this presentation, with special attention to the impact of racial and ethnic background. Key results were as follows:
- Non-Hispanic White patients had a lower median A1c at baseline (8.3%) compared to non-Hispanic Black (11.7%) and Hispanic (8.9%) patients. Relatedly, non-Hispanic White patients were more likely to be on CGM and/or insulin pumps than non-Hispanic Black or Hispanic patients, and also be on private insurance.
- Non-Hispanic Black and Hispanic patients were significantly more likely to present with DKA following COVID-19 (61% and 24% of cases, respectfully) compared to non-Hispanic White patients (7%). When data was adjusted for age, A1c, sex, and insurance type (public or private), the association between DKA and non-Hispanic Black or Hispanic identity became even stronger. Further, Non-Hispanic Black and Hispanic patients were also more likely to be hospitalized (68% and 40% of cases, respectfully) than non-Hispanic White patients (19% of cases).
To conclude his presentation, Dr. Ebekozien offered two actionable items to improve outcomes and mitigate disparities in COVID-19 and type 1 diabetes: (i) identify and redirect attention on patients susceptible to these social inequities; and (ii) stand up for systemic change in your community, taken data-driven approaches to moving policy in the right direction. Learn more about the T1D exchange COVID-19 program here. If you have time, also take a look at Dr. Ebekozien’s paper from June 2020 in Diabetes Care, which first identified an increased risk DKA presentation among type 1 diabetes patients with COVID-19.
To read the full recap on Close Concerns click here.
New Data Reveals the Social Inequities Underlying DKA Risk in Type 1 Diabetes and COVID-19 Cancel reply
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My biggest concern is if I test positive for Covid-19 how should I treat it being a Type 1 “generally healthy” diabetic that has difficulty keeping my sugars down during any flu event that may result in DKA ?