Non-Hispanic blacks with Type 1 diabetes and COVID-19 are more likely to have diabetic ketoacidosis

Non-Hispanic black patients with Type 1 diabetes and COVID-19 were almost four times as likely to present to the hospital with diabetic ketoacidosis (DKA) compared to non-Hispanic whites, according to an article published in The Journal of Clinical Endocrinology & Metabolism by Le Bonheur Pediatric Endocrinologist Kathryn Sumpter, MD.

The study examined 180 patients with Type 1 diabetes and laboratory-confirmed COVID-19 from 52 clinical sites, including Le Bonheur Children's.

The objective of the study was to evaluate instances of DKA, a serious complication of Type 1 diabetes, in patients with Type 1 diabetes and COVID-19 and determine if minorities had increased risk when controlled for sex, age, insurance and last hemoglobin A1c (HbA1c) level.

"We know that Type 2 diabetes is a risk factor for worse COVID-19 outcomes, but less is known about Type 1 diabetes and COVID," said Sumpter. "This study allowed us to examine the intersection of Type 1 diabetes and COVID while also determining the racial inequities in DKA for these patients."

Previous studies have shown that COVID-19 disproportionately affects racial and ethnic minority groups with higher rates of infection and death. The same minority groups with Type 1 diabetes have also been shown to have increased risk of DKA and associated mortality.

Because of these existing risk factors, it is critical to understand how COVID-19 and Type 1 diabetes interact and affect outcomes. The results of this study show that non-Hispanic black patients with COVID-19 and Type 1 diabetes have an additional risk of DKA beyond the risk of having diabetes or being of minority status.

The results of the study show that non-Hispanic blacks were more likely to present with DKA and COVID-19 (55%) compared with non-Hispanic whites (13%). Hispanics had almost two times greater odds of presenting with DKA compared to non-Hispanic whites, which researchers found to not be statistically significant.

A combination of factors lead to higher rates of DKA among minority Type 1 diabetes patients with COVID-19 that relate to social and structural risks. Social determinants of health, including income level, education, racial discrimination and inadequate health care access, impact these populations with devastating complications for Type 1 diabetes and COVID-19."

Kathryn Sumpter, MD, Pediatric Endocrinologist, Le Bonheur Children's Hospital

According to the study, intervention in these areas is essential to prevent these poor outcomes that unequally affect minority populations.

Source:
Journal reference:

Ebekozien, O., et al. (2020) Inequities in Diabetic Ketoacidosis Among Patients With Type 1 Diabetes and COVID-19: Data From 52 US Clinical Centers. The Journal of Clinical Endocrinology & Metabolism. doi.org/10.1210/clinem/dgaa920.

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