DKA Inequities in Type 1 Diabetes With COVID-19

Osagie Ebekozien, Shivani Agarwal, Nudrat Noor, Anastasia Albanese-O’Neill, Jenise C Wong, Tossaporn Seeherunvong, Janine Sanchez, Daniel DeSalvo, Sarah K Lyons, Shideh Majidi, Jamie R Wood, Runa Acharya, Grazia Aleppo, Kathryn M Sumpter, Anna Cymbaluk, Nirali A Shah, Michelle Van Name, Lisa Cruz-Aviles, Guy Todd Alonso, Mary Pat Gallagher, Srinath Sanda, Alexis Jamie Feuer, Kristina Cossen, Nicole Rioles, Nana-Hawa Yayah Jones, Manmohan K Kamboj, Irl B Hirsch
The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 4, April 2021, Pages e1755–e1762
https://doi.org/10.1210/clinem/dgaa920

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.

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