Odds for DKA higher for Black patients with type 1 diabetes, COVID-19
Non-Hispanic Black patients with COVID-19 and type 1 diabetes are more than three times more likely to be hospitalized for diabetic ketoacidosis compared with non-Hispanic white patients, according to study data.
“Our study highlights significant differences in acute adverse outcomes between Black and Hispanic patients diagnosed with type 1 diabetes and COVID-19 as compared to white patients,” Osagie Ebekozien, MD, MPH, vice president of population health and quality improvement at T1D Exchange and assistant professor of population health at University of Mississippi Medical Center, told Healio. “In this study, Black and Hispanic patients were significantly less likely to use diabetes technology like continuous glucose monitoring and insulin pumps. They had worse glycemic control compared to white patients. Among patients with type 1 diabetes who get infected with COVID-19, we found that Black patients are three times more likely to be hospitalized for diabetic ketoacidosis than whites, despite accounting for some potential contributing factors.”
Ebekozien and colleagues published their findings in the Journal of Clinical Endocrinology & Metabolism.
Researchers collected data on all individuals with type 1 diabetes who tested positive for COVID-19 at 52 endocrinology centers in the T1D Exchange Clinic Network. Data were obtained through an online questionnaire that was created and maintained by the T1D Exchange. Black, white and Hispanic patients with a confirmed positive COVID-19 test were included in the study. DKA status was confirmed through patient medical charts. Researchers also analyzed sociodemographic information, duration of type 1 diabetes, CGM and insulin pump use, comorbidities and presentation of COVID-19 symptoms.
Of 180 participants in the study, 62 were non-Hispanic white, 44 were non-Hispanic Black and 36 were Hispanic. The use of public insurance was higher for Black (78%) and Hispanic (72%) patients compared with white patients (30%; P = .001). Median HbA1c was higher in the Black (11%) and Hispanic (9.8%) cohorts compared with the white cohort (8.3%; P < .001). Black and Hispanic individuals were also less likely to use an insulin pump or CGM.
“Structural and systemic racism have worsened access to health care services, diabetes devices, insulin and food insecurity for Black and Hispanic patients with type 1 diabetes,” Ebekozien said. “These socioeconomic factors are associated with the prevalence of diabetic ketoacidosis, which is further exacerbated by the COVID-19 pandemic.”
A higher proportion of Black patients with type 1 diabetes and COVID-19 were hospitalized with DKA compared with white patients (55% vs. 13%; P = .001). There were also more cases of newly diagnosed type 1 diabetes among Black (13%) and Hispanic (12%) patients compared with white patients (1%; P = .001).
After adjusting for age, sex, HbA1c and insurance, Black patients had significantly greater odds of hospitalization with DKA than white patients (adjusted OR = 3.7; 95% CI, 1.4-10.6). The OR for Hispanic patients presenting with DKA compared with white patients was not significant.
Ebekozien said the findings reveal the importance for providers to focus on disparities affecting individuals with type 1 diabetes.
“As the COVID-19 pandemic evolves, clinicians should aggressively educate patients with type 1 diabetes on diabetic ketoacidosis prevention and screen for social determinants of health by asking questions about their ability to afford insulin and about food insecurity,” Ebekozien said. “It is also crucial to ensure Hispanic and Black patients have equitable access to the COVID-19 vaccines.”
For more information:
Osagie Ebekozien, MD, MPH, can be reached at firstname.lastname@example.org.