COVID-19 Hospitalization in Adults with Type 1 Diabetes: Results from the T1D Exchange Multicenter Surveillance Study

Abstract

Context Diabetes mellitus is associated with increased COVID-19 morbidity and mortality, but there is little data focusing on outcomes in people with type 1 diabetes. Objective The objective of this study was to analyze characteristics of adults with type 1 diabetes for associations with COVID-19 hospitalization. Design An observational multi-site cross-sectional study was performed. Diabetes providers answered a 33-item questionnaire regarding demographics, symptoms, and diabetes- and COVID-19-related care and outcomes. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between HbA1c, age, and comorbidities and hospitalization. Setting Cases were submitted from 52 US sites between March and August 2020. Patients or Other Participants Adults over the age of 19 with type 1 diabetes and confirmed COVID-19 infection were included. Interventions None. Main Outcome Measures Hospitalization for COVID-19 infection. Results A total of 113 cases were analyzed. Fifty-eight patients were hospitalized, and five patients died. Patients who were hospitalized were more likely to be older, to identify as non-Hispanic Black, to use public insurance, or to have hypertension, and less likely to use continuous glucose monitoring or insulin pumps. Median HbA1c was 8.6% (70 mmol/mol) and was positively associated with hospitalization (OR 1.42, 95% CI 1.18-1.76), which persisted after adjustment for age, sex, race, and obesity. Conclusions Baseline glycemic control and access to care are important modifiable risk factors which need to be addressed to optimize care of people with type 1 diabetes during the worldwide COVID-19 pandemic.

The association between COVID-19 and type 1 diabetes mellitus: A systematic review

“…Fifteen studies were finally included: Eight studies are retrospective cohort studies, three are cross-sectional studies [ [18] , [19] , [20] , [21] , [22] , [23] , [24] ], two are retrospective case-control studies [ 25 , 26 ], one is retrospective case-series [ 27 ], and one was a commentary with no clear report of a study design, but the study included original data [ 28 ]. The studied populations were patients with COVID-19 alone in two studies [ 22 , 27 ], patients with T1DM alone in five studies [ 14 , 21 , 23 , 24 , 28 ], patients with both COVID-19 and T1DM in five studies [ [18] , [19] , [20] , 29 , 30 ], and patients with either COVID-19 and T1DM (case group) and patients with T1DM alone or with COVID-19-like disease (control group) in two studies [ 25 , 26 ]. The sample size of included studies ranged from 32 participants [ 18 ] to 264,390 participants [ 21 ].…”

“…Four studies reported the clinical findings of COVID-19 in patients with T1DM [ 18 , 25 , 27 , 30 ]. Nausea and vomiting were the most common presentation of COVID-19, accounting for 71.40% (5/7) of patients in the study of Al Hayek et al [ 18 ] Dry cough was the most common presentation (51%; 58/113) in the study of O'Malley et al [ 30 ] Fever was the most common presentation (89.9%; 62/69) in the study of Yang et al [ 27 ] Finally, elevated blood glucose level was the most common presentation both in the case group (COVID-19 and T1DM; 48.5%) and in the control group (COVID-19-like disease and T1DM; 51.60%) in the study of Ebekozien et al [ 25 ] The radiographic findings of patients with both COVID-19 and T1DM were not reported in any of the included studies.…”

“…The rate of ICU admission ranged from 13.3% [ 25 ] to 25.90% [ 28 ]. Meanwhile, the rate of intubation alone (not as a composite outcome) was reported in only one study with a rate of 5.3% (6/113 patients) [ 30 ]. Meanwhile, the rate of DKA was reported in four studies [ 24 , 25 , 28 , 30 ], ranging from 24.0% [ 30 ] to 51.7% [ 28 ].…”

“…Meanwhile, the rate of intubation alone (not as a composite outcome) was reported in only one study with a rate of 5.3% (6/113 patients) [ 30 ]. Meanwhile, the rate of DKA was reported in four studies [ 24 , 25 , 28 , 30 ], ranging from 24.0% [ 30 ] to 51.7% [ 28 ]. Severe hypoglycemia was reported as an outcome in only two studies [ 25 , 30 ], with a rate of 5.31% and 3.0%, respectively.…”

“…Meanwhile, the rate of DKA was reported in four studies [ 24 , 25 , 28 , 30 ], ranging from 24.0% [ 30 ] to 51.7% [ 28 ]. Severe hypoglycemia was reported as an outcome in only two studies [ 25 , 30 ], with a rate of 5.31% and 3.0%, respectively. The rate of COVID-19-related death or mortality was 0% [ 18 ], 1.50% [ 19 ], 3.0% [ 25 ], and 4.0% in studied populations of COVID-19 and T1DM [ 30 ].…”