Differences in COVID-19 Outcomes Among Patients With Type 1 Diabetes: First vs Later Surges

Background Outcomes of the novel coronavirus SARS-CoV-2 (COVID-19) have improved throughout the pandemic. However, whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time is unknown. Therefore, we aim to investigate differences in COVID-19 outcomes for patients with T1D in the US. Method We analyzed data collected via a registry of patients with T1D and COVID-19 from 56 sites between April 2020 and January 2021. First, we grouped cases into First Surge (04/09/2020 - 07/31/2020, n=188) and Late Surge (08/01/2020 - 01/31/2021, n=410). Then, we compared outcomes between both groups using descriptive statistics and logistic regression models. Results Adverse outcomes were more frequent during the first surge including Diabetic Ketoacidosis (32% versus 15%, p<0.001), severe hypoglycemia (4% versus 1%, p=0.04) and hospitalization (52% versus 22%, p<0.001). The First surge cases were older (28 +/- 18.8 years versus 18.8 +/- 11.1 years, p<0.001), had higher hemoglobin A1c (HbA1c) levels (Median (IQR): 9.3 (4.0) versus 8.4(2.8), <0.001) and use public insurance (n(%): 107 (57) versus 154 (38), p <0.001). There were five times increased odds of hospitalization for adults (OR 5.01 (2.11,12.63) in the first surge compared to the late surge. Conclusion COVID-19 cases among patients with T1D reported during the first surge had a higher proportion of adverse outcomes than those presented in a later surge

958-P: Associations between Effect of Body-Mass Index (BMI) and HbA1c among Children and Young Adults with Type 1 Diabetes: A U.S. Based Multicenter Study

Background: The primary objective of this U.S. based multi-center study was to examine the association of overweight and obesity with A1c levels for children and adolescents with type 1 diabetes (T1D) . Methods: Electronic health record data spanning 2017-2021 for children and adolescents from the T1D Exchange Quality Improvement (T1DX-QI) Collaborative was analyzed. BMI percentiles were calculated using the Centers for Disease Control and Prevention growth curves, and children were categorized into normal weight, overweight, obese and severely obese groups. Normal weight was defined as a BMI < 85th percentile for age and sex. Overweight was defined as a BMI ≥ 85th to < 95th percentile. Obesity was defined as having a BMI <120% of the 95th percentile whereas severe obesity was defined as having BMI ≥120% of the 95th percentile. HbA1c levels and BMI were from last in-person encounter. Results: Of 14,484 T1D patients aged < 18 years, 2,063 (14%) were underweight, 9,320 (65%) normal weight, 1,769 (12%) overweight, 977 (7%) obese and 333 were severely obese (2%) . More people of Black (12%) and Hispanic (18%) race/ethnicity were in the obese group relative to the normal weight group (8% and 10% respectively; p<0.001) . HbA1c levels were higher in the obese/severely obese group compared to normal weight patients (HbA1c Mean (SD) : Obese (9.1 (2.3)) /severely obese (9.1 (2.2) vs. Normal weight: 8.7 (2.0) ; p<0.001) . Conclusion: In this extensive real-world study, we found obese children and adolescents with T1D were more likely of Black or Hispanic race/ethnicity and have higher HbA1c levels compared to those with healthy weight

Age and Hospitalization Risk in People With Type 1 Diabetes and COVID-19: Data From the T1D Exchange Surveillance Study.

CONTEXT: COVID-19 morbidity and mortality are increased in type 1 diabetes (T1D), but few data focus on age-based outcomes. OBJECTIVE: This work aimed to quantify the risk for COVID-19-related hospitalization and adverse outcomes by age in people with T1D. METHODS: For this observational, multisite, cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 56 clinical sites in the United States, data were collected from April 2020 to March 2021. The distribution of patient factors and outcomes across age groups (0-18, 19-40, and &gt; 40 years) was examined. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between age, adverse outcomes, and hospitalization. The main outcome measure was hospitalization for COVID-19. RESULTS: A total of 767 patients were analyzed. Fifty-four percent (n = 415) were aged 0 to 18 years, 32% (n = 247) were aged 19 to 40 years, and 14% (n = 105) were older than 40 years. A total of 170 patients were hospitalized, and 5 patients died. Compared to the 0- to 18-years age group, those older than 40 years had an adjusted odds ratio of 4.2 (95% CI, 2.28-7.83) for hospitalization after adjustment for sex, glycated hemoglobin A1c, race, insurance type, and comorbidities. CONCLUSION: Age older than 40 years is a risk factor for patients with T1D and COVID-19, with children and younger adults experiencing milder disease and better prognosis. This indicates a need for age-tailored treatments, immunization, and clinical management of individuals affected by T1D

Factors Associated With Achieving Target A1C in Children and Adolescents With Type 1 Diabetes: Findings From the T1D Exchange Quality Improvement Collaborative.

The optimal care of type 1 diabetes involves consistent glycemic management to avoid short- and long-term complications. However, despite advancements in diabetes technology and standards, achieving adequate glycemic levels in children and adolescents remains a challenge. This study aimed to identify factors associated with achieving the recommended A1C target of &lt;7% from the United States-based multicenter T1D Exchange Quality Improvement Collaborative cohort, including 25,383 children and adolescents living with type 1 diabetes

Comorbidities increase COVID-19 hospitalization in young people with type 1 diabetes.

ObjectivesWe evaluated COVID-19 outcomes in children and young adults with type 1 diabetes (T1D) to determine if those with comorbidities are more likely to experience severe COVID-19 compared to those without.Research design and methodsThis cross-sectional study included questionnaire data on patients &lt;25 years of age with established T1D and laboratory-confirmed COVID-19 from 52 sites across the US between April 2020 and October 2021. We examined patient factors and COVID-19 outcomes between those with and without comorbidities. Multivariate logistic regression analysis examined the odds of hospitalization among groups, adjusting for age, HbA1c, race and ethnicity, insurance type and duration of diabetes.ResultsSix hundred fifty-one individuals with T1D and COVID-19 were analyzed with mean age 15.8 (SD 4.1) years. At least one comorbidity was present in 31%, and more than one in 10%. Obesity and asthma were the most frequently reported comorbidities, present in 19% and 17%, respectively. Hospitalization occurred in 17% of patients and 52% of hospitalized patients required ICU level care. Patients with at least one comorbidity were almost twice as likely to be hospitalized with COVID-19 than patients with no comorbidities (Odds ratio 2.0, 95% CI: 1.3-3.1). This relationship persisted after adjusting for age, HbA1c, race and ethnicity (minority vs nonminority), insurance type (public vs. private), and duration of diabetes.ConclusionsOur findings show that comorbidities increase the risk for hospitalization with COVID-19 in children and young adults highlighting the need for tailored COVID-19 prevention and treatment strategies in T1D

Age and Hospitalization Risk in People With Type 1 Diabetes and COVID-19: Data From the T1D Exchange Surveillance Study

Context COVID-19 morbidity and mortality are increased in type 1 diabetes (T1D), but few data focus on age-based outcomes. Objective This work aimed to quantify the risk for COVID-19-related hospitalization and adverse outcomes by age in people with T1D. Methods For this observational, multisite, cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 56 clinical sites in the United States, data were collected from April 2020 to March 2021. The distribution of patient factors and outcomes across age groups (0-18, 19-40, and > 40 years) was examined. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between age, adverse outcomes, and hospitalization. The main outcome measure was hospitalization for COVID-19. Results A total of 767 patients were analyzed. Fifty-four percent (n = 415) were aged 0 to 18 years, 32% (n = 247) were aged 19 to 40 years, and 14% (n = 105) were older than 40 years. A total of 170 patients were hospitalized, and 5 patients died. Compared to the 0- to 18-years age group, those older than 40 years had an adjusted odds ratio of 4.2 (95% CI, 2.28-7.83) for hospitalization after adjustment for sex, glycated hemoglobin A(1c), race, insurance type, and comorbidities. Conclusion Age older than 40 years is a risk factor for patients with T1D and COVID-19, with children and younger adults experiencing milder disease and better prognosis. This indicates a need for age-tailored treatments, immunization, and clinical management of individuals affected by T1D

Demographic, clinical, management and outcome characteristics of 8,004 young children with type 1 diabetes

Objective: To compare demographic, clinical, and therapeutic characteristics of children with type 1 diabetes aged <6 years across three international registries: Diabetes Prospective Follow-up Registry (DPV, Europe), T1D Exchange Quality Improvement Network (T1DX-QI, USA) and Australasian Diabetes Data Network (ADDN, Australasia). Research Design and Methods: Analysis of 2019-2021 prospective registry data from 8,004 children were compared. Results: Mean±SD age at diabetes diagnosis was 3.2±1.4 (DPV, ADDN), and 3.7±1.8 years (T1DX-QI). Diabetes duration was 1.4±1.3 (DPV), 1.4±1.6 (T1DX-QI), and 1.5±1.3 years (ADDN). and BMI z scores were in the overweight range in 36.2% (DPV), 41.8% (T1DX-QI), and 50.0% (ADDN). and Mean±SD HbA1c varied between registries: DPV 7.3±0.9% (56±10mmol/mol, T1DX-QI 8.0±1.4% (64±16mmol/mol), ADDN 7.7±1.2% (61±13mmol/mol). Overall, 37.5% of children achieved target HbA1c of <7.0% (53mmol/mol); 43.6% in DPV, 25.5% in T1DX-QI and 27.5% in ADDN. Use of diabetes technologies varied between registries for use of insulin pump: DPV 86.6%, T1DX 46.6%, and ADDN 39.2%; and continuous glucose monitoring (CGM): DPV 85.1%, T1DX-QI 57.6%, and ADDN 70.5%. Use of hybrid closed loop (HCL) systems was uncommon (0.5% (ADDN) to 6.9% (DPV)). Conclusions: Across three major registries, over half of children aged <6 years did not achieve target HbA1c of <7.0% (53 mmol/mol). CGM was used by most participants, while insulin pump use varied across registries and HCL use was rare. The differences seen in glycemia and use of diabetes technologies between registries requires further investigation to determine potential contributing factors and areas to target to improve the care of this vulnerable group.</p

<b>Insulin Pump Utilization in 2017–2021 for More Than 22,000 Children and Adults With Type 1 Diabetes: A Multicenter Observational Study</b>

This large type 1 diabetes cohort study showed that insulin pump utilization has increased over time and that use differs by sex, insurance type, and race/ethnicity. Insulin pump use was associated with more optimal A1C, increased use of continuous glucose monitoring (CGM), and lower rates of diabetic ketoacidosis and severe hypoglycemia. People who used an insulin pump with CGM had lower rates of acute events than their counterparts who used an insulin pump without CGM. These findings highlight the need to improve access of diabetes technology through provider engagement, multidisciplinary approaches, and efforts to address health inequities.</p

Diabetic ketoacidosis drives COVID-19 related hospitalizations in children with type 1 diabetes.

BackgroundDiabetes is a risk factor for poor COVID-19 outcomes, but pediatric patients with type 1 diabetes are poorly represented in current studies.MethodsT1D Exchange coordinated a US type 1 diabetes COVID-19 registry. Forty-six diabetes centers submitted pediatric cases for patients with laboratory confirmed COVID-19. Associations between clinical factors and hospitalization were tested with Fisher's Exact Test. Logistic regression was used to calculate odds ratios for hospitalization.ResultsData from 266 patients with previously established type 1 diabetes aged &lt;19 years with COVID-19 were reported. Diabetic ketoacidosis (DKA) was the most common adverse outcome (n&nbsp;=&nbsp;44, 72% of hospitalized patients). There were four hospitalizations for severe hypoglycemia, three hospitalizations requiring respiratory support (one of whom was intubated and mechanically ventilated), one case of multisystem inflammatory syndrome in children, and 10 patients who were hospitalized for reasons unrelated to COVID-19 or diabetes. Hospitalized patients (n&nbsp;=&nbsp;61) were more likely than nonhospitalized patients (n&nbsp;=&nbsp;205) to have minority race/ethnicity (67% vs 39%, P &lt; 0.001), public insurance (64% vs 41%, P &lt; 0.001), higher A1c (11% [97 mmol/mol] vs 8.2% [66 mmol/mol], P &lt; 0.001), and lower insulin pump and lower continuous glucose monitoring use (26% vs 54%, P &lt; 0.001; 39% vs 75%, P &lt; 0.001). Age and gender were not associated with risk of hospitalization. Higher A1c was significantly associated with hospitalization, with an odds ratio of 1.56 (1.34-1.84) after adjusting for age, gender, insurance, and race/ethnicity.ConclusionsHigher A1c remained the only predictor for hospitalization with COVID-19. Diabetic ketoacidosis is the primary concern among this group