New Study Uncovers Racial Inequities Among People with Type 1 Diabetes, COVID-19

Black and Hispanic people with COVID-19 and diabetes are more likely than Caucasians to die or have serious complications, according to a new study published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Health disparities refer to unequal health status or healthcare between groups of people due to differences in their background, physical traits, or their environment. These differences include race/ethnicity, country of origin, sex, income, and disability. Minorities are disproportionately affected by diabetes and COVID-19 and are more likely to develop serious complications like diabetic ketoacidosis, a condition that occurs when your body produces high levels of blood acids.

“Our findings of troubling and significant inequities call for urgent and targeted interventions, such as culturally appropriate diabetic ketoacidosis awareness campaigns, increased continuous glucose monitoring coverage for minority patients and health care provider participation in a Quality Improvement Collaborative.” – Osagie Ebekozien, MD, MPH, of the T1D Exchange in Boston, Mass.

“This is the first major study to examine racial-ethnic inequities for people with type 1 diabetes and COVID-19 that are brought on by structural and systemic racism,” says study author Osagie Ebekozien, MD, MPH, of the T1D Exchange in Boston, Mass. “We used a diverse cohort of patients with type 1 diabetes and found there is a significantly increased risk of worse outcomes for Black and Hispanic patients with COVID-19 and diabetes.”

The researchers analyzed data from 180 people with type 1 diabetes and COVID-19 from 52 clinical sites in the United States. The study found Black patients were four times more likely to be hospitalized for diabetic ketoacidosis than Caucasians. Black and Hispanic patients were also less likely to use diabetes technology like continuous glucose monitors (CGMs) and insulin pumps, and they had worse glycemic control than Caucasian patients.

“Our findings of troubling and significant inequities call for urgent and targeted interventions, such as culturally appropriate diabetic ketoacidosis awareness campaigns, increased continuous glucose monitoring coverage for minority patients and health care provider participation in a Quality Improvement Collaborative,” Ebekozien says.

Other authors of the study include: Shivani Agarwal of the Albert Einstein College of Medicine in the Bronx, N.Y.; Nudrat Noor and Nicole Rioles of the T1D Exchange; Anastasia Albanese-O’Neil of the University of Florida in Gainesville, Fla.; Jenise C. Wong and Srinath Sanda of the Madison Clinic for Pediatric Diabetes at the University of California San Francisco in San Francisco, Calif.; Tossaporn Seeherunvong and Janine Sanchez of the University of Miami Miller School of Medicine in Miami, Fla.; Daniel DeSalvo, Sarah K. Lyons and Anna Cymbaluk of the Texas Children’s Hospital at Baylor College of Medicine in Houston, Texas; Shideh Majidi and Guy Todd Alonso of the University of Colorado in Denver, Colo.; Jamie R. Wood of the Case Western Reserve University in Cleveland, Ohio; Runa Acharya of the SUNY Upstate Medical University in Syracuse, N.Y.; Grazia Aleppo of Northwestern University in Chicago, Ill.; Kathryn M. Sumpter of Le Bonheur Children’s Hospital in Memphis, Tenn.; Nirali A. Shah of the Icahn School of Medicine at Mount Sinai in New York, N.Y.; Michelle Van Name and Lisa Cruz-Aviles of the Yale School of Medicine in New Haven, Conn.; Mary Pat Gallagher of NYU Langone Health in Brooklyn, N.Y.; Alexis Jamie Feuer of Weill Cornell Medicine in New York, N.Y.; Kristina Cossen of Children Healthcare of Atlanta in Atlanta, Ga.; Nana-Hawa Yayah Jones of the Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio; Manmohan K. Kamboj of the Nationwide Children Hospital in Columbus, Ohio; and Irl B. Hirsch of the University of Washington School of Medicine in Seattle, Wash.

The manuscript received funding from the Juvenile Diabetes Research Foundation, the Insulet Corporation, Medtronic, Dexcom, Eli Lilly and Company, Tandem, the Leona M. and Harry B. Helmsley Charitable Trust, Abbott Diabetes Care, and the National Institute of Diabetes and Digestive and Kidney Diseases.

The manuscript, “Inequities in Diabetic Ketoacidosis among Patients with Type 1 Diabetes and COVID 19: Data from 52 US Clinical Centers,” was published online, ahead of print.

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