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

Author:

Ebekozien Osagie1ORCID,Agarwal Shivani2ORCID,Noor Nudrat1,Albanese-O’Neill Anastasia3,Wong Jenise C4,Seeherunvong Tossaporn5,Sanchez Janine5,DeSalvo Daniel6,Lyons Sarah K6,Majidi Shideh7,Wood Jamie R8,Acharya Runa9,Aleppo Grazia10,Sumpter Kathryn M11,Cymbaluk Anna6,Shah Nirali A12,Van Name Michelle13,Cruz-Aviles Lisa13,Alonso Guy Todd7,Gallagher Mary Pat14,Sanda Srinath4,Feuer Alexis Jamie15,Cossen Kristina16,Rioles Nicole1,Jones Nana-Hawa Yayah17,Kamboj Manmohan K18,Hirsch Irl B19

Affiliation:

1. T1D Exchange, Boston, MA, USA

2. Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY, USA

3. University of Florida, Gainesville, FL, USA

4. Madison Clinic for Pediatric Diabetes, University of California San Francisco, CA, USA

5. Miller School of Medicine, University of Miami, Maimi, FL, USA

6. Texas Children’s Hospital/Baylor College of Medicine, Houston, TX, USA

7. Barbara Davis Center for Diabetes, University of Colorado, Denver, CO, USA

8. UH Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH, USA

9. SUNY Upstate Medical University, NY, USA

10. Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

11. Le Bonheur Children’s Hospital, University of Tennesse Health Science Center, Memphis, Tennesse, TN, USA

12. Icahn School of Medicine at Mount Sinai, New York, NY, USA

13. Yale School of Medicine, New Haven, CT, USA

14. Hassenfeld Children’s Hospital, NYU Langone, New York, NY, USA

15. Division of Pediatric Endocrinology, Weill Cornell Medicine, New York, NY, USA

16. Children’s Hospital of Atlanta, Emory University School of Medicine, Atlanta, GA, USA

17. Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

18. Nationwide Children Hospital, Columbus, OH, USA

19. University of Washington Diabetes Institute, Seattle, WA, USA

Abstract

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.

Funder

NIDDK

Publisher

The Endocrine Society

Subject

Biochemistry (medical),Clinical Biochemistry,Endocrinology,Biochemistry,Endocrinology, Diabetes and Metabolism

Reference31 articles.

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