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Straton E, Bryant BL, Kang L, Wang C, Barber J, Perkins A, Gallant L, Marks B, Agarwal S, Majidi S, Monaghan M, Streisand R. ROUTE-T1D: A behavioral intervention to promote optimal continuous glucose monitor use among racially minoritized youth with type 1 diabetes: Design and development. Contemp Clin Trials 2024; 140:107493. [PMID: 38460913 PMCID: PMC11065587 DOI: 10.1016/j.cct.2024.107493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/13/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Type 1 diabetes management is often challenging during adolescence, and many youth with type 1 diabetes struggle with sustained and optimal continuous glucose monitor (CGM) use. Due to racial oppression and racially discriminatory policies leading to inequitable access to quality healthcare and life necessities, racially minoritized youth are significantly less likely to use CGM. METHODS ROUTE-T1D: Research on Optimizing the Use of Technology with Education is a pilot behavioral intervention designed to promote optimal CGM use among racially minoritized youth with type 1 diabetes. Intervention strategies include problem solving CGM challenges and promoting positive caregiver-youth communication related to CGM data. RESULTS This randomized waitlist intervention provides participants with access to three telemedicine sessions with a Certified Diabetes Care and Education Specialist. Caregiver participants are also connected with a peer-parent coach. CONCLUSION Hypothesized findings and anticipated challenges are discussed. Future directions regarding sustaining and optimizing the use of diabetes technology among racially minoritized pediatric populations are reviewed.
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Affiliation(s)
- Emma Straton
- Children's National Hospital, Washington DC, United States of America
| | - Breana L Bryant
- Children's National Hospital, Washington DC, United States of America
| | - Leyi Kang
- Children's National Hospital, Washington DC, United States of America
| | - Christine Wang
- Children's National Hospital, Washington DC, United States of America
| | - John Barber
- Children's National Hospital, Washington DC, United States of America
| | - Amanda Perkins
- Children's National Hospital, Washington DC, United States of America
| | - Letitia Gallant
- Children's National Hospital, Washington DC, United States of America
| | - Brynn Marks
- Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Shivani Agarwal
- Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Shideh Majidi
- Children's National Hospital, Washington DC, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America
| | - Maureen Monaghan
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Randi Streisand
- Children's National Hospital, Washington DC, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
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2
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Been RA, Lameijer A, Gans ROB, van Beek AP, Kingsnorth AP, Choudhary P, van Dijk PR. The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: a narrative review. Ther Adv Endocrinol Metab 2024; 15:20420188241236289. [PMID: 38476216 PMCID: PMC10929059 DOI: 10.1177/20420188241236289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
Continuous glucose monitoring (CGM) usage has been shown to improve disease outcomes in people living with diabetes by facilitating better glycemic management. However, previous research has suggested that access to these devices can be influenced by nonmedical factors such as socioeconomic status and ethnicity. It is critical that equitable access to CGM devices is ensured as people from those groups experience poorer diabetes-related health outcomes. In this narrative review, we provide an overview of the various healthcare systems worldwide and how socioeconomic status, social context, and ethnicity shape device usage and the associated health outcomes. In general, we found that having a lower socioeconomic status and belonging to an ethnic minority group negatively impact CGM usage. While financial means proved to be an important mediator in this process, it was not the sole driver as disparities persisted even after adjustment for factors such as income and insurance status. Recommendations to increase CGM usage for people of a lower socioeconomic status and ethnic minorities include increasing the availability of financial, administrative, and educational support, for both patients and healthcare providers. However, recommendations will vary due to local country-specific circumstances, such as reimbursement criteria and healthcare ecosystems.
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Affiliation(s)
- Riemer A. Been
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Annel Lameijer
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Reinold O. B. Gans
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, The Netherlands
| | - André P. van Beek
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Groningen, The Netherlands
| | - Andrew P. Kingsnorth
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Pratik Choudhary
- University of Leicester, Leicester General Hospital, Leicester, Leicester Diabetes Centre – Bloom, UK
| | - Peter R. van Dijk
- University of Groningen, University Medical Center Groningen, Department of Endocrinology, Hanzeplein 1, Groningen, 9713 GZ, The Netherlands
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Mathias P, Corathers SD, Carreon SA, Hilliard ME, Papadakis JL, Weissberg-Benchell J, Raymond JK, Pyatak EA, Agarwal S. Young Adults with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:39-52. [PMID: 38272597 DOI: 10.1016/j.ecl.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Young adults experience multiple developmental transitions across social, educational, vocational, residential, and financial life domains. These transitions are potential competing priorities to managing a chronic condition such as type 1 diabetes and can contribute to poor psychosocial and medical outcomes. In this narrative review, we describe population outcomes of young adult populations and the unique considerations associated with managing type 1 diabetes in young adulthood. We provide an overview of the current evidence-based strategies to improve care for young adults with type 1 diabetes and recommendations for future directions in the field.
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Affiliation(s)
- Priyanka Mathias
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA
| | - Sarah D Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Samantha A Carreon
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Jaclyn L Papadakis
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jennifer K Raymond
- Division of Pediatric Endocrinology, Children's Hospital Los Angeles, 4650 Sunset Boulevard. MS 61, Los Angeles, CA, USA
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, 1540 Alcazar Street, CHP-133, Los Angeles, CA 90089-9003, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA; NY Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, 1180 Morris Park Avenue, Bronx, NY 10467, USA.
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4
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Wu V, Choleva L, Wilkes M. Optimizing Glycemic Outcomes for Children with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:27-38. [PMID: 38272596 DOI: 10.1016/j.ecl.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Changes in physical growth, neurocognitive development, and pubertal maturation are some of the challenges to achieving blood glucose targets in children with type 1 diabetes mellitus. To optimize glycemic outcomes, a comprehensive approach is crucial to address psychosocial needs, expand the use of diabetes technology, and diminish health inequities.
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Affiliation(s)
- Vickie Wu
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA
| | - Lauryn Choleva
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA
| | - Meredith Wilkes
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, The Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Box #1616, Annenberg Building, 4th Floor, New York, NY 10029, USA.
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Ebekozien O, Mungmode A, Hardison H, Rapaport R. Improving Outcomes for People with Type 1 Diabetes Through Collaboration: Summary of Type 1 Diabetes Exchange Quality Improvement Collaborative Studies. Endocrinol Metab Clin North Am 2024; 53:1-16. [PMID: 38272589 DOI: 10.1016/j.ecl.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Type 1 diabetes (T1D) management has evolved over the last decade. Innovations and groundbreaking research have paved the way for improved outcomes for people with T1D. One of the major T1D focused research network that has supported real-world research studies in the United States is the T1D Exchange Quality Improvement Collaborative (T1DX-QI) Network.T1DX-QI is a large multicenter network of 55 T1D clinics that uses quality improvement, health equity framework, and population health principles to improve outcomes for people with T1D. This article summarizes insights from T1DX-QI clinical and population health improvement studies.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA, USA; University of Mississippi School of Population Health, Jackson, MS, USA.
| | | | | | - Robert Rapaport
- Department of Pediatrics at Icahn School of Medicine; Mount Sinai Kravis Children's Hospital, New York, NY, USA
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6
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Breidbart E, Gallagher MP. Type 1 and Covid-19: Diagnosis, Clinical Care, and Health Outcomes during the Pandemic. Endocrinol Metab Clin North Am 2024; 53:135-149. [PMID: 38272592 DOI: 10.1016/j.ecl.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic disrupted health care, creating challenges for people with diabetes and health care systems. Diabetes was recognized as a risk factor for severe disease early in the pandemic. Subsequently, risk factors specific for people with type 1 diabetes were identified, including age, hemoglobin A1c level, and lack of continuous glucose monitoring . Telemedicine, especially when accompanied by diabetes data, allowed effective remote care delivery. However, pre-existing racial disparities in access to diabetes technology persisted and were associated with worse outcomes. Events of the COVID-19 pandemic underscore the importance of continuing to develop flexible and more equitable health care delivery systems.
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Affiliation(s)
- Emily Breidbart
- Department of Pediatrics, Division of Pediatric Endocrinology, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone Health, 135 East 31st Street, Level 2, New York, NY 10016, USA.
| | - Mary Pat Gallagher
- Department of Pediatrics, Division of Pediatric Endocrinology, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone Health, 135 East 31st Street, Level 2, New York, NY 10016, USA
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7
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Ebekozien O. The Evolving Landscape of Type 1 Diabetes Management. Endocrinol Metab Clin North Am 2024; 53:xvii-xix. [PMID: 38272603 DOI: 10.1016/j.ecl.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, 101 Federal Street, Boston, MA 02110, USA; John D Bower School of Population Health, University of Mississippi, Jackson, MS 39216, USA.
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8
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Al-Hindi B, Mohammed MA, Mangantig E, Martini ND. Prevalence of sodium-glucose transporter 2 inhibitor-associated diabetic ketoacidosis in real-world data: A systematic review and meta-analysis. J Am Pharm Assoc (2003) 2024; 64:9-26.e6. [PMID: 37844733 DOI: 10.1016/j.japh.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/30/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The U.S. Food and Drug Administration (FDA) revised the labels of sodium-glucose transporter 2 (SGLT2) inhibitors in December 2015 to inform users regarding the risk of diabetic ketoacidosis (DKA). As more drugs of this class are approved and their indications are expanded, this serious adverse effect has been increasingly reported. OBJECTIVE This review evaluated observational studies to inform the prevalence of SGLT2-inhibitor-associated DKA compared with other antihyperglycemic agents. METHODS A systematic review was conducted in PubMed and EMBASE until 19 July 2022 (PROSPERO: CRD42022385425). We included published retrospective cohort active comparator/new user (ACNU) and prevalent new user studies assessing SGLT2-inhibitor-associated DKA prevalence in adult patients with type 2 diabetes mellitus (T2DM) against active comparators. We excluded studies which lacked 1:1 propensity score matching. The JBI Checklist for Cohort Studies guided the risk-of-bias assessments. Meta-analysis was conducted based on the inverse variance method in R software. RESULTS Sixteen studies with a sample of 2,956,100 nonunique patients met the inclusion criteria. Most studies were conducted in North America (n = 9) and adopted the ACNU design (n = 15). Meta-analysis of 14 studies identified 33% higher DKA risk associated with SGLT2 inhibitors (HR = 1.33, 95% CI: 1.14-1.55, P < 0.01). Meta-regression analysis identified the study location (P = 0.02), analysis principle (P < 0.001), exclusion of chronic comorbidities (P = 0.007), and canagliflozin (P = 0.04) as significant moderator variables. CONCLUSIONS Despite limitations related to heterogeneity, generalizability, and misclassification, the results of this study show that SGLT2 inhibitors increase the prevalence of DKA among adult T2DM patients in the real world. The findings supplement evidence from randomized controlled trials (RCTs) and call for continued vigilance.
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9
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Cai Y, Zhang YF, Wu SQ, Xia CY, Yang Q, Li DT, Jiang Q, Hu P. Interpreting with caution of the higher occurrence of pediatric new-onset type 1 diabetes during the COVID-19 pandemic. Diabetes Res Clin Pract 2023; 206:111030. [PMID: 38013119 DOI: 10.1016/j.diabres.2023.111030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Ying Cai
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Yan Fang Zhang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Shu Qi Wu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Cai Yun Xia
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Qian Yang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Dao Ting Li
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Qi Jiang
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China
| | - Peng Hu
- Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, PR China.
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10
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Ebekozien O. Roadmap to Achieving Continuous Glucose Monitoring Equity: Insights From the T1D Exchange Quality Improvement Collaborative. Diabetes Spectr 2023; 36:320-326. [PMID: 37982057 PMCID: PMC10654123 DOI: 10.2337/dsi23-0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
This article describes successful interventions from the T1D Exchange Quality Improvement Collaborative (T1DX-QI) to reduce inequities in access to and use of continuous glucose monitoring (CGM). The author proposes a roadmap with recommendations for different stakeholders to achieve CGM equity using insights from the T1DX-QI experience.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA, and the University of Mississippi School of Population Health, Jackson, MS
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11
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Odugbesan O, Mungmode A, Rioles N, Buckingham D, Nelson G, Agarwal S, Grant A, Wright T, Hess E, Ebekozien O. Increasing Continuous Glucose Monitoring Use for Non-Hispanic Black and Hispanic People With Type 1 Diabetes: Results From the T1D Exchange Quality Improvement Collaborative Equity Study. Clin Diabetes 2023; 42:40-48. [PMID: 38230339 PMCID: PMC10788664 DOI: 10.2337/cd23-0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Despite the benefits of continuous glucose monitoring (CGM), there is lower use of this technology among non-Hispanic Black and Hispanic people with type 1 diabetes compared with their non-Hispanic White counterparts. The T1D Exchange Quality Improvement Collaborative recruited five endocrinology centers to pilot an equity-focused quality improvement (QI) study to reduce racial inequities in CGM use. The centers used rapid QI cycles to test and expand interventions such as provider bias training, translation of CGM materials, provision of CGM education in multiple languages, screening for social determinants of health, and shared decision-making. After implementation of these interventions, median CGM use increased by 7% in non-Hispanic White, 12% in non-Hispanic Black, and 15% in Hispanic people with type 1 diabetes. The gap between non-Hispanic White and non-Hispanic Black patients decreased by 5%, and the gap between non-Hispanic White and Hispanic patients decreased by 8%.
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Affiliation(s)
| | | | | | | | - Grace Nelson
- Le Bonheur Children’s Hospital, University of Tennessee, Memphis, TN
| | - Shivani Agarwal
- Albert Einstein College of Medicine–Montefiore Medical Center, Bronx, NY
| | - Amy Grant
- Cincinnati Children Hospital Medical Center, Columbus, OH
| | | | - Emilie Hess
- SUNY Upstate Medical University, Syracuse, NY
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi Medical Center School of Population Health, Jackson, MS
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Gandhi K, Ebekozien O, Noor N, McDonough RJ, Hsieh S, Miyazaki B, Dei-Tutu S, Golden L, Desimone M, Hardison H, Rompicherla S, Akturk HK, Kamboj MK. Insulin Pump Utilization in 2017-2021 for More Than 22,000 Children and Adults With Type 1 Diabetes: A Multicenter Observational Study. Clin Diabetes 2023; 42:56-64. [PMID: 38230341 PMCID: PMC10788665 DOI: 10.2337/cd23-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
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.
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Affiliation(s)
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Tosur M, Hsu JW, Deen S, Huang X, Guffey D, Uysal S, Astudillo M, Redondo MJ, Jahoor F, Balasubramanyam A. Plasma amino acid signatures define types of pediatric diabetes. Clin Nutr ESPEN 2023; 57:21-28. [PMID: 37739658 PMCID: PMC10518839 DOI: 10.1016/j.clnesp.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Metabolic biomarkers with pathophysiological relevance is lacking in pediatric diabetes. We aimed to identify novel metabolic biomarkers in pediatric type 1 (T1D) and type 2 diabetes (T2D). We hypothesized that (1) targeted plasma metabolomics, focused on plasma amino acid concentrations, could identify distinctively altered patterns in children with T1D or T2D, and (2) there are specific changes in concentrations of metabolites related to branch chain amino acids (BCAA) and arginine metabolism in children with T2D. METHODS In a pilot study, we enrolled children with T1D (n = 15) and T2D (n = 13), and healthy controls (n = 15). Fasting plasma amino acid concentrations were measured by ultra-performance liquid chromatography, and compared between the groups after adjustment for confounding factors. RESULTS The mean age (SD) of participants was 16.4 (0.9) years. There were no group differences in age, gender, race/ethnicity, or 24-h protein intake. Mean BMI percentile was higher in the T2D than the T1D group or controls (p < 0.001). The T2D group had lower arginine, citrulline, glutamine, glycine, phenylalanine, methionine, threonine, asparagine and symmetric dimethylarginine (SDMA) but higher aspartate than controls, after adjusting for BMI percentiles (all p < 0.05). Children with T2D also had lower glycine but higher ornithine, proline, leucine, isoleucine, valine, total BCAA, lysine and tyrosine than those with T1D after adjusting for confounding factors (all p < 0.05). Children with T1D had lower phenylalanine, methionine, threonine, glutamine, tyrosine, asymmetric dimethylarginine (ADMA) and SDMA than controls (all p < 0.05). CONCLUSIONS Children with T2D and T1D have distinct fasting plasma amino acid signatures that suggest varying pathogenic mechanisms and could serve as biomarkers for these conditions.
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Affiliation(s)
- Mustafa Tosur
- Department of Pediatrics, Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA; Children's Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Houston, TX, USA.
| | - Jean W Hsu
- Children's Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Houston, TX, USA; Department of Pediatrics - Nutrition, Baylor College of Medicine, Houston, TX, USA
| | - Saima Deen
- Department of Pediatrics, Research Resources Office, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Xiaofan Huang
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Danielle Guffey
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Serife Uysal
- Department of Pediatrics, Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Marcela Astudillo
- Department of Pediatrics, Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Maria J Redondo
- Department of Pediatrics, Division of Diabetes and Endocrinology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Farook Jahoor
- Children's Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture, Houston, TX, USA; Department of Pediatrics - Nutrition, Baylor College of Medicine, Houston, TX, USA
| | - Ashok Balasubramanyam
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX, USA.
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Miyazaki B, Ebekozien O, Rompicherla S, Ohmer A, Guttman-Bauman I, Mucci A, Guarneri A, Raman V, Smego A, Dickinson JK. Association Between Health Insurance Type and Adverse Outcomes for Children and Young Adults With Type 1 Diabetes and Coronavirus Disease 2019. Diabetes Spectr 2023; 36:398-402. [PMID: 38024220 PMCID: PMC10654127 DOI: 10.2337/ds23-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Background Health insurance coverage type differs significantly by socioeconomic status and racial group in the United States. The aim of this study was to determine whether publicly insured children and young adults with type 1 diabetes were more likely to experience adverse outcomes compared with privately insured patients with acute coronavirus disease 2019 (COVID-19) infections. Methods Data from 619 patients with previously established type 1 diabetes who were <24 years of age with acute COVID-19 infections were analyzed from the T1D Exchange COVID-19 surveillance registry. Data for the registry was collected from 52 endocrinology clinics across the United States using an online survey tool. Each site completed the survey using electronic health record data between April 2020 and December 2021. Results Of the 619 patients included in this study, 257 had public insurance and 362 had private insurance. Of the 257 publicly insured patients with COVID-19, 57 reported severe adverse outcomes (22%), defined as diabetic ketoacidosis (DKA) or severe hypoglycemia. In comparison, there were 25 reported adverse outcomes (7%) among the 362 privately insured patients. Conclusion Our data reveal high rates of hospitalization and DKA among publicly insured racial/ethnic minority children and young adults with type 1 diabetes and COVID-19.
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Affiliation(s)
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
| | | | - Amy Ohmer
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI
| | - Ines Guttman-Bauman
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Andrea Mucci
- Department of Pediatric Endocrinology, Cleveland Clinic Children’s Hospital, Cleveland, OH
| | | | - Vandana Raman
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Allison Smego
- Department of Pediatrics, University of Utah, Salt Lake City, UT
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15
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Conway RB, Gerard Gonzalez A, Shah VN, Geno Rasmussen C, Akturk HK, Pyle L, Forlenza G, Alonso GT, Snell-Bergeon J. Racial Disparities in Diabetes Technology Adoption and Their Association with HbA1c and Diabetic Ketoacidosis. Diabetes Metab Syndr Obes 2023; 16:2295-2310. [PMID: 37551339 PMCID: PMC10404403 DOI: 10.2147/dmso.s416192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
Aim Poorer glycemic control and higher diabetic ketoacidosis (DKA) rates are seen in racial/ethnic minorities with type 1 diabetes (T1D). Use of diabetes technologies such as continuous glucose monitors (CGM), continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems has been shown to improve glycemic control and reduce DKA risk. We examined race/ethnicity differences in diabetes technology use and their relationship with HbA1c and DKA. Methods Data from patients aged ≥12 years with T1D for ≥1 year, receiving care from a single diabetes center, were examined. Patients were classified as Non-Hispanic White (n=3945), Non-Hispanic Black (Black, n=161), Hispanic (n=719), and Multiracial/Other (n=714). General linear models and logistic regression were used. Results Black (OR=0.22, 0.15-0.32) and Hispanic (OR=0.37, 0.30-0.45) patients were less likely to use diabetes technology. This disparity was greater in the pediatric population (p-interaction=0.06). Technology use associated with lower HbA1c in each race/ethnic group. Among technology users, AID use associated with lower HbA1c compared to CGM and/or CSII (HbA1c of 8.4% vs 9.2%, respectively), with the greatest difference observed for Black adult AID users. CSII use associated with a lower odds of DKA in the past year (OR=0.73, 0.54-0.99), a relationship that did not vary by race (p-interaction =0.69); this inverse association with DKA was not observed for CGM or AID. Conclusion Disparities in diabetes technology use, DKA, and glycemic control were apparent among Black and Hispanic patients with T1D. Differences in technology use ameliorated but did not fully account for disparities in HbA1c or DKA.
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Affiliation(s)
- Rebecca Baqiyyah Conway
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Viral N Shah
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Halis Kaan Akturk
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Laura Pyle
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory Forlenza
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Guy Todd Alonso
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Janet Snell-Bergeon
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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16
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Khunti K, Feldman EL, Laiteerapong N, Parker W, Routen A, Peek M. The Impact of the COVID-19 Pandemic on Ethnic Minority Groups With Diabetes. Diabetes Care 2023; 46:228-236. [PMID: 35944272 PMCID: PMC10090266 DOI: 10.2337/dc21-2495] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/10/2022] [Indexed: 02/03/2023]
Abstract
Major ethnic disparities in diabetes care, especially for intermediate outcomes and diabetes complications, were evident prior to the coronavirus disease 2019 (COVID-19) pandemic. Diabetes is a risk factor for severe COVID-19, and the combination of these ethnic disparities in diabetes care and outcomes may have contributed to the inequity in COVID-19 outcomes for people with diabetes. Overall, ethnic minority populations have suffered disproportionate rates of COVID-19 hospitalization and mortality. Results from the limited number of studies of COVID-19 in ethnic minority populations with diabetes are mixed, but there is some suggestion that rates of hospitalization and mortality are higher than those of White populations. Reasons for the higher incidence and severity of COVID-19-related outcomes in minority ethnic groups are complex and have been shown to be due to differences in comorbid conditions (e.g., diabetes), exposure risk (e.g., overcrowded living conditions or essential worker jobs), and access to treatment (e.g., health insurance status and access to tertiary care medical centers), which all relate to long-standing structural inequities that vary by ethnicity. While guidelines and approaches for diabetes self-management and outpatient and inpatient care during the pandemic have been published, few have recommended addressing wider structural issues. As we now plan for the recovery and improved surveillance and risk factor management, it is imperative that primary and specialist care services urgently address the disproportionate impact the pandemic has had on ethnic minority groups. This should include a focus on the larger structural barriers in society that put ethnic minorities with diabetes at potentially greater risk for poor COVID-19 outcomes.
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Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Eva L. Feldman
- Department of Neurology, School of Medicine, University of Michigan, Ann Arbor, MI
| | | | - William Parker
- Department of Pulmonary and Critical Care, University of Chicago, Chicago, IL
| | - Ash Routen
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - Monica Peek
- Department of Medicine, University of Chicago, Chicago, IL
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17
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Muacevic A, Adler JR, Breve F, Magnusson PM, Varrassi G. Exploring the Implications of New-Onset Diabetes in COVID-19: A Narrative Review. Cureus 2023; 15:e33319. [PMID: 36741600 PMCID: PMC9894635 DOI: 10.7759/cureus.33319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023] Open
Abstract
Post-viral new-onset diabetes has been an important feature of the COVID-19 pandemic. It is not always clear if new-onset diabetes is the unmasking of a previously undiagnosed condition, the acceleration of prediabetes, or new-onset diabetes that would not have otherwise occurred. Even asymptomatic cases of COVID-19 have been associated with new-onset diabetes. Diabetes that emerges during acute COVID-19 infection tends to have an atypical presentation, characterized by hyperglycemia and potentially life-threatening diabetic ketoacidosis. It is not always clear if new-onset diabetes is type 1 or type 2 diabetes mellitus. Many cases of COVID-associated diabetes appear to be type 1 diabetes, which is actually an autoimmune disorder. The clinical course varies temporally and with respect to outcomes; in some cases, diabetes resolves completely or improves incrementally after recovery from COVID-19. Disruptions in macrophagy caused by COVID-19 infection along with an exaggerated inflammatory response that can occur in COVID-19 also play a role. Those who survive COVID-19 remain at a 40% elevated risk for diabetes in the first year, even if their case of COVID-19 was not particularly severe. A subsequent post-pandemic wave of new diabetes patients may be expected.
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18
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Pietropaolo M, Hotez P, Giannoukakis N. Incidence of an Insulin-Requiring Hyperglycemic Syndrome in SARS-CoV-2-Infected Young Individuals: Is It Type 1 Diabetes? Diabetes 2022; 71:2656-2663. [PMID: 35293987 PMCID: PMC9862279 DOI: 10.2337/db21-0831] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/27/2022] [Indexed: 02/05/2023]
Abstract
Pancreatic ACE2 receptor expression, together with increased prevalence of insulin-requiring hyperglycemia in patients with coronavirus disease 2019 (COVID-19), suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pancreatic infection might trigger a β-cell-selective inflammation precipitating autoimmune type 1 diabetes (T1D). We examined T1D incidence in patients with COVID-19 inside a large, global population using a "big data" approach. The incidence in 0-30-year-old patients with confirmed COVID-19 over an ∼15-month period from the beginning of the COVID-19 pandemic was compared with an age-matched population without COVID-19 inside the TriNetX COVID-19 Research Network (>80 million deidentified patient electronic medical records globally). The cohorts were used to generate outcomes of T1D postindex. In those up to 18 years of age, the incidence of insulin-requiring diabetes that could represent T1D in patients with already diagnosed, confirmed COVID-19 was statistically indistinguishable from the control population without COVID-19. In contrast, in those aged 19-30 years, the incidence was statistically greater. These data suggest that the incidence of T1D among patients with COVID-19 <30 years of age, at least up to this time since the beginning of the pandemic, is not greater when compared with an age-, sex-, and BMI-matched population without COVID-19. Nevertheless, we caution that patients with COVID-19 could be asymptomatic of a diabetic/prediabetic state and therefore would not be expected to come to medical attention, remaining undiagnosed. Hence, it is still possible that asymptomatic virus-infected individuals could acquire β-cell autoimmunity, eventually progressing to dysglycemia and clinical T1D at higher rates.
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Affiliation(s)
- Massimo Pietropaolo
- Diabetes Research Center, Section of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX
| | - Peter Hotez
- Texas Children’s Hospital Center for Vaccine Development, Departments of Pediatrics and Molecular Virology and Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, TX
| | - Nick Giannoukakis
- Institute of Cellular Therapeutics, Allegheny Health Network, Pittsburgh, PA
- Corresponding author: Nick Giannoukakis,
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19
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Mann EA, Rompicherla S, Gallagher MP, Alonso GT, Fogel NR, Simmons J, Wood JR, Wong JC, Noor N, Gomez P, Daniels M, Ebekozien O. Comorbidities increase COVID-19 hospitalization in young people with type 1 diabetes. Pediatr Diabetes 2022; 23:968-975. [PMID: 36054578 PMCID: PMC9538459 DOI: 10.1111/pedi.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/22/2022] [Accepted: 08/14/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We 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 METHODS This cross-sectional study included questionnaire data on patients <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. RESULTS Six 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. CONCLUSIONS Our 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.
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Affiliation(s)
- Elizabeth A Mann
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, UW Health Kids, Madison, Wisconsin, USA
| | | | | | - Guy Todd Alonso
- Department of Pediatrics, University of Colorado, Barbara Davis Center, Aurora, Colorado, USA
| | - Naomi R Fogel
- Ann & Robert H. Lurie Children's Hospital of Chicago, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jill Simmons
- Department of Pediatrics, Vanderbilt Children Hospital, Nashville, Tennessee, USA
| | - Jamie R Wood
- Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jenise C Wong
- Department of Pediatrics, University of California, San Francisco, California, USA
| | | | - Patricia Gomez
- Department of Pediatrics, University of Miami, Miami, Florida, USA
| | - Mark Daniels
- Children Hospital of Orange County, Orange, California, USA
| | - Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts, USA.,University of Mississippi School of Population Health, Jackson, Mississippi, USA
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20
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Odugbesan O, Addala A, Nelson G, Hopkins R, Cossen K, Schmitt J, Indyk J, Jones NHY, Agarwal S, Rompicherla S, Ebekozien O. Implicit Racial-Ethnic and Insurance-Mediated Bias to Recommending Diabetes Technology: Insights from T1D Exchange Multicenter Pediatric and Adult Diabetes Provider Cohort. Diabetes Technol Ther 2022; 24:619-627. [PMID: 35604789 PMCID: PMC9422789 DOI: 10.1089/dia.2022.0042] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Despite documented benefits of diabetes technology in managing type 1 diabetes, inequities persist in the use of these devices. Provider bias may be a driver of inequities, but the evidence is limited. Therefore, we aimed to examine the role of race/ethnicity and insurance-mediated provider implicit bias in recommending diabetes technology. Method: We recruited 109 adult and pediatric diabetes providers across 7 U.S. endocrinology centers to complete an implicit bias assessment composed of a clinical vignette and ranking exercise. Providers were randomized to receive clinical vignettes with differing insurance and patient names as proxy for Racial-Ethnic identity. Bias was identified if providers: (1) recommended more technology for patients with an English name (Racial-Ethnic bias) or private insurance (insurance bias), or (2) Race/Ethnicity or insurance was ranked high (Racial-Ethnic and insurance bias, respectively) in recommending diabetes technology. Provider characteristics were analyzed using descriptive statistics and multivariate logistic regression. Result: Insurance-mediated implicit bias was common in our cohort (n = 66, 61%). Providers who were identified to have insurance-mediated bias had greater years in practice (5.3 ± 5.3 years vs. 9.3 ± 9 years, P = 0.006). Racial-Ethnic-mediated implicit bias was also observed in our study (n = 37, 34%). Compared with those without Racial-Ethnic bias, providers with Racial-Ethnic bias were more likely to state that they could recognize their own implicit bias (89% vs. 61%, P = 0.001). Conclusion: Provider implicit bias to recommend diabetes technology was observed based on insurance and Race/Ethnicity in our pediatric and adult diabetes provider cohort. These data raise the need to address provider implicit bias in diabetes care.
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Affiliation(s)
- Ori Odugbesan
- T1D Exchange, QI & Population Health Department, Boston, Massachusetts, USA
| | - Ananta Addala
- Stanford University, Division of Pediatric Endocrinology & Diabetes, Lucile Packard Children's Hospital, Stanford, California, USA
| | - Grace Nelson
- Le Bonheur Children's Hospital, Pediatric Endocrinology, Memphis, Tennessee, USA
| | - Rachel Hopkins
- SUNY Upstate Medical Center, Division of Endocrinology and Metabolism, Syracuse, New York, USA
| | - Kristina Cossen
- Children's Healthcare of Atlanta, Division of Pediatric Endocrinology, Atlanta, Georgia, USA
| | - Jessica Schmitt
- The University of Alabama Pediatric Endocrinology and Diabetes at Birmingham Hospital, Birmingham, Alabama, USA
| | - Justin Indyk
- Nationwide Children Hospital, Division of Endocrinology, Columbus, Ohio, USA
| | | | - Shivani Agarwal
- Yeshiva University Albert Einstein College of Medicine, Division of Endocrinology, Bronx, New York, USA
| | - Saketh Rompicherla
- T1D Exchange, QI & Population Health Department, Boston, Massachusetts, USA
| | - Osagie Ebekozien
- T1D Exchange, QI & Population Health Department, Boston, Massachusetts, USA
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21
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Nimri R, Rachmiel M, Yackobovitch-Gavan M, Brener A, de Vries L, Fisch Shvalb N, Lazar L, Oren A, Jacobi-Polishook T, Shefer Averbuch N, Tenenbaum A, Mel E, Krepel Volsky S, Mouler M, Demol S, Shalitin S, Bello R, Phillip M, Lebenthal Y. Symptoms and Glycemic Control in Young People With Type 1 Diabetes Following SARS-CoV-2 Infection: An Observational Study. J Clin Endocrinol Metab 2022; 107:e3264-e3272. [PMID: 35524727 PMCID: PMC9129169 DOI: 10.1210/clinem/dgac288] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Indexed: 02/07/2023]
Abstract
CONTEXT Data is needed regarding the effect of SARS-CoV-19 infection on young people with established type 1 diabetes. Identifying the disease outcomes, short and long-term sequelae may help to establish an evidence-based prevention and education policy for sick days management and DKA prevention. OBJECTIVE This work aims to describe clinical manifestations of SARS-CoV-2 infection in children, adolescents, and young adults with established type 1 diabetes (T1D) and explore the effects of COVID-19 on glycemic control and disease course. METHODS An observational study was conducted at 3 pediatric diabetes clinics in Israel between mid-March 2020 and mid-March 2021. Included were young people with established T1D, age younger than 30 years, who tested positive for SARS-CoV-2 (quantitative real-time polymerase chain reaction). Data were collected from medical files, diabetes devices, and COVID-19 questionnaire. Outcome measures were analyzed by the presence/absence of clinical symptoms (symptomatic/asymptomatic) and by age group (pediatric, < 19 years/young adults, 19-30 years). RESULTS Of 132 patients, mean age 16.9 ± 5.3years, with COVID-19-confirmed infection, 103 (78%) had related symptoms; the most common were headaches, fatigue, fever, and loss of sense of smell. All had a mild disease course, but 4 required hospitalization and 2 cases were directly related to COVID-19 infection (pleuropneumonia in a patient with immunodeficiency syndrome, 1 case of diabetic ketoacidosis). Logistic regression analysis showed that age (odds ratio [OR] = 1.11; 95% CI, 1.01-1.23; P = .033), elevated glucose levels (OR = 5.23; 95% CI, 1.12-24.41; P = .035), and comorbidities (OR = 8.21; 95% CI, 1.00-67.51; P = .050) were positively associated with symptomatic infection. Persistent symptoms occurred in 16.5% of the cohort over a median of 6.7 months; age (OR = 1.14; 95% CI, 1.01-1.29; P = .030) and elevated glucose levels (OR = 3.42; 95% CI, 1.12-10.40; P = .031) were positively associated with persistent symptoms. Usually, no change was reported in glucose levels (64%) except for a temporary deterioration in glycemic control during the short infection period. CONCLUSION Young people with established T1D experience mild COVID-19 infection. Elevated glucose levels during COVID-19 infection and older age were associated with prolonged disease course.
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Affiliation(s)
- Revital Nimri
- Correspondence: Revital Nimri, MD, The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 14 Kaplan St, Petah Tikva, 49202, Israel. ;
| | - Marianna Rachmiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
- Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Tzrifin,70300, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Avivit Brener
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Childrens Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv,6423906, Israel
| | - Liat de Vries
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Naama Fisch Shvalb
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Liora Lazar
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Asaf Oren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Childrens Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv,6423906, Israel
| | - Talia Jacobi-Polishook
- Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Tzrifin,70300, Israel
| | - Noa Shefer Averbuch
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Ariel Tenenbaum
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Eran Mel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
| | - Sari Krepel Volsky
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Marie Mouler
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Sharon Demol
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Shlomit Shalitin
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Rachel Bello
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva 49202, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Yael Lebenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Childrens Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv,6423906, Israel
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22
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Xu NY, Nguyen KT, DuBord AY, Pickup J, Sherr JL, Teymourian H, Cengiz E, Ginsberg BH, Cobelli C, Ahn D, Bellazzi R, Bequette BW, Gandrud Pickett L, Parks L, Spanakis EK, Masharani U, Akturk HK, Melish JS, Kim S, Kang GE, Klonoff DC. Diabetes Technology Meeting 2021. J Diabetes Sci Technol 2022; 16:1016-1056. [PMID: 35499170 PMCID: PMC9264449 DOI: 10.1177/19322968221090279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 4 to November 6, 2021. This meeting brought together speakers to discuss various developments within the field of diabetes technology. Meeting topics included blood glucose monitoring, continuous glucose monitoring, novel sensors, direct-to-consumer telehealth, metrics for glycemia, software for diabetes, regulation of diabetes technology, diabetes data science, artificial pancreas, novel insulins, insulin delivery, skin trauma, metabesity, precision diabetes, diversity in diabetes technology, use of diabetes technology in pregnancy, and green diabetes. A live demonstration on a mobile app to monitor diabetic foot wounds was presented.
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Affiliation(s)
- Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
| | | | | | | | | | | | - Eda Cengiz
- University of California, San
Francisco, San Francisco, CA, USA
| | | | | | - David Ahn
- Mary & Dick Allen Diabetes Center
at Hoag, Newport Beach, CA, USA
| | | | | | | | - Linda Parks
- University of California, San
Francisco, San Francisco, CA, USA
| | - Elias K. Spanakis
- Baltimore VA Medical Center,
Baltimore, MD, USA
- University of Maryland, Baltimore,
MD, USA
| | - Umesh Masharani
- University of California, San
Francisco, San Francisco, CA, USA
| | - Halis K. Akturk
- Barbara Davis Center for Diabetes,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Sarah Kim
- University of California, San
Francisco, San Francisco, CA, USA
| | - Gu Eon Kang
- The University of Texas at Dallas,
Richardson, TX, USA
| | - David C. Klonoff
- Diabetes Research Institute,
Mills-Peninsula Medical Center, San Mateo, CA, USA
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23
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Lavik AR, Ebekozien O, Noor N, Alonso GT, Polsky S, Blackman SM, Chen J, Corathers SD, Demeterco-Berggren C, Gallagher MP, Greenfield M, Garrity A, Rompicherla S, Rapaport R, Yayah Jones NH. Trends in Type 1 Diabetic Ketoacidosis During COVID-19 Surges at 7 US Centers: Highest Burden on non-Hispanic Black Patients. J Clin Endocrinol Metab 2022; 107:1948-1955. [PMID: 35380700 PMCID: PMC8992309 DOI: 10.1210/clinem/dgac158] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 12/26/2022]
Abstract
CONTEXT The impact of the COVID-19 pandemic on individuals with type 1 diabetes remains poorly defined. OBJECTIVE We examined United States trends in diabetic ketoacidosis (DKA) among individuals with type 1 diabetes (T1D) during the COVID-19 pandemic at 7 large US medical centers and factors associated with these trends. METHODS We compared DKA events among children and adults with T1D during COVID-19 surge 1 (March-May 2020) and COVID-19 surge 2 (August-October 2020) to the same periods in 2019. Analysis was performed using descriptive statistics and chi-square tests. RESULTS We found no difference in the absolute number of T1D patients experiencing DKA in 2019 vs 2020. However, a higher proportion of non-Hispanic Black (NHB) individuals experienced DKA in 2019 than non-Hispanic White (NHW) individuals (44.6% vs 16.0%; P < .001), and this disparity persisted during the COVID-19 pandemic (48.6% vs 18.6%; P < .001). DKA was less common among patients on continuous glucose monitor (CGM) or insulin pump in 2020 compared to 2019 (CGM: 13.2% vs 15.0%, P < .001; insulin pump: 8.0% vs 10.6%, P < .001). In contrast to annual DKA totals, a higher proportion of patients had DKA during COVID-19 surges 1 and 2 compared to the same months in 2019 (surge 1: 7.1% vs 5.4%, P < .001; surge 2: 6.6% vs 5.7%, P = .001). CONCLUSION DKA frequency increased among T1D patients during COVID-19 surges with highest frequency among NHB patients. DKA was less common among patients using CGM or insulin pumps. These findings highlight the urgent need for improved strategies to prevent DKA among patients with T1D-not only under pandemic conditions, but under all conditions-especially among populations most affected by health inequities.
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Affiliation(s)
- Andrew R Lavik
- Correspondence: Andrew R. Lavik, MD, PhD, Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
| | | | - Nudrat Noor
- T1D Exchange, Boston, Massachusetts 02111, USA
| | - G Todd Alonso
- University of Colorado, Barbara Davis Center for Diabetes, Aurora, Colorado 80045, USA
| | - Sarit Polsky
- University of Colorado, Barbara Davis Center for Diabetes, Aurora, Colorado 80045, USA
| | - Scott M Blackman
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Justin Chen
- SUNY Upstate Medical University, Syracuse, New York 13210, USA
| | - Sarah D Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
| | | | - Mary Pat Gallagher
- Hassenfeld Children’s Hospital at NYU Langone, New York, New York 10016, USA
| | | | - Ashley Garrity
- Division of Pediatric Endocrinology, C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | | | - Nana-Hawa Yayah Jones
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
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Wolf RM, Noor N, Izquierdo R, Jett D, Rewers A, Majidi S, Sheanon N, Breidbart E, Demeterco‐Berggren C, Lee JM, Kamboj MK, Ebekozien O. Increase in newly diagnosed type 1 diabetes in youth during the COVID-19 pandemic in the United States: A multi-center analysis. Pediatr Diabetes 2022; 23:433-438. [PMID: 35218124 PMCID: PMC9115477 DOI: 10.1111/pedi.13328] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND An increase in newly diagnosed type 1 diabetes (T1D) has been posited during the COVID-19 pandemic, but data are conflicting. We aimed to determine trends in newly diagnosed T1D and severity of presentation at diagnosis for pediatric and adolescent patients during COVID-19 (2020) as compared to the previous year (2019) in a multi-center analysis across the United States. METHODS This retrospective study from seven centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI) included data on new onset T1D diagnosis and proportion in DKA at diagnosis from January 1 to December 31, 2020, compared to the prior year. Chi-square tests were used to compare differences in patient characteristics during the pandemic period compared to the prior year. RESULTS Across seven sites, there were 1399 newly diagnosed T1D patients in 2020, compared to 1277 in 2019 (p = 0.007). A greater proportion of newly diagnosed patients presented in DKA in 2020 compared to 2019 (599/1399(42.8%) vs. 493/1277(38.6%), p = 0.02), with a higher proportion presenting with severe DKA (p = 0.01) as characterized by a pH <7.1 and/or bicarbonate of <5 mmol/L. Monthly data trends demonstrated a higher number of new T1D diagnoses over the spring and summer months (March to September) of 2020 compared to 2019 (p < 0.001). CONCLUSIONS We found an increase in newly diagnosed T1D and a greater proportion presenting in DKA at diagnosis during the COVID-19 pandemic compared to the prior year. Future longitudinal studies are needed to confirm these findings with population level data and determine the long-term impact of COVID-19 on diabetes trends.
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Affiliation(s)
- Risa M. Wolf
- Department of Pediatrics, Division of Pediatric EndocrinologyJohns Hopkins MedicineBaltimoreMarylandUSA
| | | | | | - Destiny Jett
- SUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | | | | | - Nicole Sheanon
- Cincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | | | | | - Joyce M. Lee
- Mott Children's Hospital, Susan B. Meister Child Health Evaluation and Research CenterUniversity of MichiganAnn ArborMichiganUSA
| | | | - Osagie Ebekozien
- T1D ExchangeBostonMassachusettsUSA,University of Mississippi Medical CenterJacksonMississippiUSA
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Qeadan F, Tingey B, Egbert J, Pezzolesi MG, Burge MR, Peterson KA, Honda T. The associations between COVID-19 diagnosis, type 1 diabetes, and the risk of diabetic ketoacidosis: A nationwide cohort from the US using the Cerner Real-World Data. PLoS One 2022; 17:e0266809. [PMID: 35439266 PMCID: PMC9017888 DOI: 10.1371/journal.pone.0266809] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the risk of new-onset type 1 diabetes mellitus (T1D) diagnosis following COVID-19 diagnosis and the impact of COVID-19 diagnosis on the risk of diabetic ketoacidosis (DKA) in patients with prior T1D diagnosis. RESEARCH DESIGN AND METHODS Retrospective data consisting of 27,292,879 patients from the Cerner Real-World Data were used. Odds ratios, overall and stratified by demographic predictors, were calculated to assess associations between COVID-19 and T1D. Odds ratios from multivariable logistic regression models, adjusted for demographic and clinical predictors, were calculated to assess adjusted associations between COVID-19 and DKA. Multiple imputation with multivariate imputation by chained equations (MICE) was used to account for missing data. RESULTS The odds of developing new-onset T1D significantly increased in patients with COVID-19 diagnosis (OR: 1.42, 95% CI: 1.38, 1.46) compared to those without COVID-19. Risk varied by demographic groups, with the largest risk among pediatric patients ages 0-1 years (OR: 6.84, 95% CI: 2.75, 17.02) American Indian/Alaskan Natives (OR: 2.30, 95% CI: 1.86, 2.82), Asian or Pacific Islanders (OR: 2.01, 95% CI: 1.61, 2.53), older adult patients ages 51-65 years (OR: 1.77, 95% CI: 1.66, 1.88), those living in the Northeast (OR: 1.71, 95% CI: 1.61, 1.81), those living in the West (OR: 1.65, 95% CI: 1.56, 1.74), and Black patients (OR: 1.59, 95% CI: 1.47, 1.71). Among patients with diagnosed T1D at baseline (n = 55,359), 26.7% (n = 14,759) were diagnosed with COVID-19 over the study period. The odds of developing DKA for those with COVID-19 were significantly higher (OR 2.26, 95% CI: 2.04, 2.50) than those without COVID-19, and the largest risk was among patients with higher Elixhauser Comorbidity Index. CONCLUSIONS COVID-19 diagnosis is associated with significantly increased risk of new-onset T1D, and American Indian/Alaskan Native, Asian/Pacific Islander, and Black populations are disproportionately at risk. In patients with pre-existing T1D, the risk of developing DKA is significantly increased following COVID-19 diagnosis.
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Affiliation(s)
- Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola Univesity Chicago, Maywood, Illinois, United States of America
- * E-mail:
| | - Benjamin Tingey
- Parkinson School of Health Sciences and Public Health, Loyola Univesity Chicago, Maywood, Illinois, United States of America
| | - Jamie Egbert
- Parkinson School of Health Sciences and Public Health, Loyola Univesity Chicago, Maywood, Illinois, United States of America
| | - Marcus G. Pezzolesi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Mark R. Burge
- Department of Internal Medicine, University of New Mexico Hospital, Albuquerque, New Mexico, United States of America
| | - Kathryn A. Peterson
- Department of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Trenton Honda
- School of Clinical and Rehabilitation Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, United States of America
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dos Santos Mamed M, Gastaldi G. COVID: The Missing Trigger to Start a Remote FIT Course. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:834082. [PMID: 36992774 PMCID: PMC10012057 DOI: 10.3389/fcdhc.2022.834082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022]
Abstract
Type 1 diabetes management is a highly demanding task that largely falls on people with diabetes, their family, and their peers. Diabetes self-management education and support aim at increasing knowledge, skills, and confidence to take appropriate diabetes management decisions. The current evidence shows that efficient diabetes self-management relies on person-centered interventions and a team of pluri-disciplinary educators with expertise in diabetes care and education. The irruption of the COVID-19 pandemic has increased diabetes burden and the need to offer remote diabetes self-management education services. The present article offers a perspective about expectations and quality issues related to the implementation of a remote version of the FIT course, a validated structured diabetes management educational program.
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Affiliation(s)
- Marcelo dos Santos Mamed
- Institute of Psychology and Education, University of Neuchatel, Neuchâtel, Switzerland
- *Correspondence: Giacomo Gastaldi, ; Marcelo dos Santos Mamed,
| | - Giacomo Gastaldi
- Department of Medicine, Diabetology Unit, Geneva University Hospital, Geneva, Switzerland
- *Correspondence: Giacomo Gastaldi, ; Marcelo dos Santos Mamed,
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27
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Chambers MA, Mecham C, Arreola EV, Sinha M. Rise in Pediatric New Onset Diabetes and Diabetic Ketoacidosis During the COVID-19 Pandemic. Endocr Pract 2022; 28:479-485. [PMID: 35189332 PMCID: PMC8855612 DOI: 10.1016/j.eprac.2022.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/15/2022] [Accepted: 02/14/2022] [Indexed: 01/08/2023]
Abstract
Objective Infection with SARS-CoV-2 induces a proinflammatory state that causes hyperglycemia and may precipitate diabetic ketoacidosis (DKA) in patients with known or new-onset diabetes. We examined the trends in new-onset diabetes and DKA prior to and following the onset of the COVID-19 pandemic. Methods This single-center retrospective observational study included pediatric patients (aged 0 to <18 years) hospitalized with new-onset type 1 diabetes or type 2 diabetes (T2D) before (March 1, 2018, to February 29, 2020) and after (March 1, 2020 to December 31, 2020) the pandemic onset. Demographic, anthropometrics, laboratory and clinical data, and outcomes were obtained. Results Among 615 children admitted with new-onset diabetes during the entire study period, 401 were admitted before the pandemic onset, and 214 were admitted after the pandemic onset. Children admitted with new-onset diabetes in the postpandemic period were significantly more likely to present with DKA (odds ratio, 1.76; 95% confidence interval, 1.24-2.52) than in the prepandemic phase. Children with DKA after the pandemic onset had higher lengths of hospitalization and were significantly more likely to experience severe DKA (odds ratio, 2.17; 95% confidence interval, 1.34-3.52). A higher proportion of children with DKA admitted to the pediatric intensive care unit required oxygen support after the pandemic onset than before the pandemic onset (8.85% vs 1.92%). Most cases of T2D with DKA occurred following the onset of the pandemic (62.5%). Conclusion A significant increase in T2D cases occurred following the onset of the COVID-19 pandemic with a greater risk of DKA and severe ketoacidosis. Racial disparity was evident with a higher proportion of Black and American Indian children presenting with ketoacidosis following the pandemic onset.
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28
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Demeterco-Berggren C, Ebekozien O, Rompicherla S, Jacobsen L, Accacha S, Gallagher MP, Todd Alonso G, Seyoum B, Vendrame F, Haw JS, Basina M, Levy CJ, Maahs DM. Age and Hospitalization Risk in People With Type 1 Diabetes and COVID-19: Data From the T1D Exchange Surveillance Study. J Clin Endocrinol Metab 2022; 107:410-418. [PMID: 34581790 PMCID: PMC8500098 DOI: 10.1210/clinem/dgab668] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Indexed: 01/08/2023]
Abstract
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 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.
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Affiliation(s)
- Carla Demeterco-Berggren
- Rady Children’s Hospital, University of California, San Diego, San Diego, California 92123, USA
- Correspondence: Carla Demeterco-Berggren, MD, PhD, Rady Children’s Hospital, University of California, San Diego, 7960, Birmingham Dr, Ste 4111, San Diego CA, 92123, USA.
| | - Osagie Ebekozien
- T1D Exchange, Boston, Massachusetts 02111, USA
- University of Mississippi School Medical Center, Jackson, Mississippi 39216, USA
| | | | | | | | | | - G Todd Alonso
- Barbara Davis Center, University of Colorado, Aurora, Colorado 80045, USA
| | | | | | | | - Marina Basina
- Stanford University, Stanford, California 94305, USA
| | - Carol J Levy
- Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
| | - David M Maahs
- Stanford University, Stanford, California 94305, USA
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29
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Ebekozien O, Mungmode A, Odugbesan O, Majidi S, Prahalad P, Noor N, Rioles N, Agarwal S, Weinstock RS, Rapaport R, Kamboj M. Addressing type 1 diabetes health inequities in the United States: Approaches from the T1D Exchange QI Collaborative. J Diabetes 2022; 14:79-82. [PMID: 34874109 PMCID: PMC9060069 DOI: 10.1111/1753-0407.13235] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Affiliation(s)
- Osagie Ebekozien
- T1D ExchangeBostonMassachusettsUSA
- University of Mississippi School of Population HealthJacksonMississippiUSA
| | | | | | | | | | | | | | | | | | - Robert Rapaport
- Mount Sinai Kravis Children's HospitalIcahn School of MedicineNew YorkNew YorkUSA
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30
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Akturk HK, Rompicherla S, Rioles N, Desimone M, Weinstock RS, Haw SJ, Ziemer DC, Dickinson JK, Agarwal S, Ebekozien O, Polsky S. Factors Associated With Improved A1C Among Adults With Type 1 Diabetes in the United States. Clin Diabetes 2022; 41:76-80. [PMID: 36714244 PMCID: PMC9845074 DOI: 10.2337/cd22-0067] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Many adults with diabetes do not reach optimal glycemic targets, and, despite advances in diabetes management, diabetes technology use remains significantly lower in racial/ethnic minority groups. This study aimed to identify factors associated with achieving the recommended A1C target of <7% using data on 12,035 adults with type 1 diabetes from 15 centers participating in the T1D Exchange Quality Improvement Collaborative. Individuals attaining the target A1C were more likely to be older, White, have private health insurance, and use diabetes technology and less likely to report depressive symptoms or episodes of severe hypoglycemia or diabetic ketoacidosis than those with higher A1C levels. These findings highlight the importance of overcoming inequities in diabetes care.
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Affiliation(s)
- Halis K. Akturk
- Barbara Davis Center, Denver, CO
- Corresponding author: Halis K. Akturk,
| | | | | | | | | | | | | | | | - Shivani Agarwal
- Albert Einstein College of Medicine–Montefiore Medical Center, Bronx, NY
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MI
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31
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Mungmode A, Noor N, Weinstock RS, Izquierdo R, Indyk JA, DeSalvo DJ, Corathers S, Demeterco-Berggen C, Hsieh S, Jacobsen LM, Mekhoubad A, Akturk HK, Wirsch A, Scott ML, Chao LC, Miyazaki B, Malik FS, Ebekozien O, Clements M, Alonso GT. Making Diabetes Electronic Medical Record Data Actionable: Promoting Benchmarking and Population Health Improvement Using the T1D Exchange Quality Improvement Portal. Clin Diabetes 2022; 41:45-55. [PMID: 36714251 PMCID: PMC9845086 DOI: 10.2337/cd22-0072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This article describes how the T1D Exchange Quality Improvement Collaborative leverages an innovative web platform, the QI Portal, to gather and store electronic medical record (EMR) data to promote benchmarking and population health improvement in a type 1 diabetes learning health system. The authors explain the value of the QI Portal, the process for mapping center-level data from EMRs using standardized data specifications, and the QI Portal's unique features for advancing population health.
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Affiliation(s)
- Ann Mungmode
- T1D Exchange, Boston, MA
- Corresponding author: Ann Mungmode,
| | | | | | | | - Justin A. Indyk
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | | | - Sarah Corathers
- Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | | | | | - Halis Kaan Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | | | | | - Lily C. Chao
- Children’s Hospital Los Angeles, Los Angeles, CA
| | | | - Faisal S. Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
| | - Mark Clements
- Children's Mercy – Kansas City, University of Missouri, Kansas City, MO
| | - G. Todd Alonso
- Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO
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Ospelt E, Noor N, Sanchez J, Nelson G, Rioles N, Malik FS, Basina M, Indyk J, Vendrame F, Schmitt J, Scott ML, Ebekozien O. Facilitators and Barriers to Smart Insulin Pen Use: A Mixed-Method Study of Multidisciplinary Stakeholders From Diabetes Teams in the United States. Clin Diabetes 2022; 41:56-67. [PMID: 36714258 PMCID: PMC9845084 DOI: 10.2337/cd22-0068] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study sought to identify barriers and facilitators to successful smart insulin pen (SIP) use and gauge prescribing practices and integration into clinical practice by assessing provider and care team perspectives at participating endocrinology clinics within the T1D Exchange Quality Improvement Collaborative. The identified provider-related, patient-related, and clinic- and operational-level barriers and facilitators varied based on clinic knowledge, capacity, and resources. High-impact barriers included insurance coverage and prescribing processes; high-impact facilitators included improved diabetes clinic visit quality and use of SIPs as an alternative to insulin pump therapy. Findings indicated the need for provider and care team education and training on proper SIP features, use, and prescribing.
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Affiliation(s)
- Emma Ospelt
- T1D Exchange, Boston, MA
- Corresponding author: Emma Ospelt,
| | | | - Janine Sanchez
- University of Miami Miller School of Medicine, Miami, FL
| | | | | | | | | | | | | | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Ebekozien O, Mungmode A, Buckingham D, Greenfield M, Talib R, Steenkamp D, Haw JS, Odugbesan O, Harris M, Mathias P, Dickinson JK, Agarwal S. Achieving Equity in Diabetes Research: Borrowing From the Field of Quality Improvement Using a Practical Framework and Improvement Tools. Diabetes Spectr 2022; 35:304-312. [PMID: 36072814 PMCID: PMC9396719 DOI: 10.2337/dsi22-0002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There are limited tools to address equity in diabetes research and clinical trials. The T1D Exchange has established a 10-step equity framework to advance equity in diabetes research. Herein, the authors outline this approach and expand on its practical application.
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Affiliation(s)
- Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
- Corresponding author: Osagie Ebekozien,
| | | | | | | | | | | | - J. Sonya Haw
- Grady Memorial Hospital, Emory University, Atlanta, GA
| | | | | | - Priyanka Mathias
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | | | - Shivani Agarwal
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
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SARS-CoV-2 infection in hospitalized children with type 1 and type 2 diabetes. J Clin Transl Endocrinol 2021; 26:100271. [PMID: 34729361 PMCID: PMC8553361 DOI: 10.1016/j.jcte.2021.100271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 12/12/2022] Open
Abstract
COVID-19 is associated with increased incidence of pediatric type 1 and 2 diabetes. COVID-19 is associated with increased incidence of DKA in new-onset type 1 diabetes. Management of hyperglycemia is difficult during severe COVID-19.
Context While diabetes is a risk factor for severe illness from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in adults, there is conflicting data surrounding the relationship between the virus and diabetic disease process in children. Objective This case series aims to illustrate an increase in the incidence of types 1 and 2 diabetes mellitus (T1DM, T2DM) between April – November 2020 at a large tertiary care children’s hospital and examine the characteristics and adverse outcomes in these children. In addition, two children with significant complications from coronavirus disease 2019 (COVID-19) and diabetes are highlighted. Methods Hospitalized children with T1DM or T2DM and SARS-CoV-2 infection were identified, and electronic medical records were reviewed. Results We observed a 16.3% increased rate of new-onset T1DM and 205.3% increased rate of new-onset insulin-dependent T2DM between April and November 2020 when compared to the same observational time frame in 2019. Among children with new-onset T1DM, 56.9% presented with DKA in 2019 and 47.1% in 2018 compared to 64.3% in 2020, which was higher than the national average. Twenty-eight children were diagnosed with COVID-19 and diabetes during this time. The 2 described cases with significant complications from COVID-19 and DKA required large doses of intravenous insulin over a prolonged duration. Conclusion This study highlights that the COVID-19 pandemic might have led to an increased rate of new-onset T1DM, T2DM, and DKA in children and adolescents compared to a similar time frame in the prior 2 years. The clinical phenotypes and outcomes in children with diabetes to COVID-19 infection may be distinct and therefore, future pediatric specific studies are needed to define the role of SARS-CoV-2.
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Figueroa-Pizano MD, Campa-Mada AC, Carvajal-Millan E, Martinez-Robinson KG, Chu AR. The underlying mechanisms for severe COVID-19 progression in people with diabetes mellitus: a critical review. AIMS Public Health 2021; 8:720-742. [PMID: 34786431 PMCID: PMC8568590 DOI: 10.3934/publichealth.2021057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023] Open
Abstract
Diabetes mellitus (DM) has a high incidence of comorbidities among patients with severe coronavirus disease 2019 (COVID-19). The elevated prevalence of DM in the world population makes it a significant risk factor because diabetic individuals appear to be prone to clinical complications and have increased mortality rates. Here, we review the possible underlying mechanisms involved in DM that led to worse outcomes in COVID-19. The impacts of hyperglycemia side effects, secondary comorbidities, weakened innate and adaptive immunity, chronic inflammation, and poor nutritional status, commonly present in DM, are discussed. The role of the SARS-CoV-2 receptor and its polymorphic variations on higher binding affinity to facilitate viral uptake in people with DM were also considered. Clinical differences between individuals with type 1 DM and type 2 DM affected by COVID-19 and the potential diabetogenic effect of SARS-CoV-2 infection were addressed.
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Affiliation(s)
- María D Figueroa-Pizano
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Alma C Campa-Mada
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Elizabeth Carvajal-Millan
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Karla G Martinez-Robinson
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
| | - Agustin Rascon Chu
- Research Center for Food and Development, CIAD, AC, Carretera Gustavo Enrique Astiazarán Rosas No. 46, C.P. 83304, Hermosillo, Sonora, México
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Alhumaid S, Al Mutair A, Al Alawi Z, Rabaan AA, Alomari MA, Al Salman SA, Al-Alawi AS, Al Hassan MH, Alhamad H, Al-kamees MA, Almousa FM, Mufti HN, Alwesabai AM, Dhama K, Al-Tawfiq JA, Al-Omari A. Diabetic ketoacidosis in patients with SARS-CoV-2: a systematic review and meta-analysis. Diabetol Metab Syndr 2021; 13:120. [PMID: 34702335 PMCID: PMC8547563 DOI: 10.1186/s13098-021-00740-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND One possible reason for increased mortality due to SARS-CoV-2 in patients with diabetes is from the complication of diabetic ketoacidosis (DKA). OBJECTIVES To re-evaluate the association of SARS-CoV-2 and development of DKA and analyse the demographic and biochemical parameters and the clinical outcomes in COVID-19 patients with DKA. DESIGN A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed. METHODS Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, Scopus and Nature) were searched from 1 December 2019 to 30 June 2021 in the English language using the following keywords alone or in combination: COVID-19 OR SARS-CoV-2 AND diabetic ketoacidosis OR DKA OR ketosis OR ketonemia OR hyperglycaemic emergency OR hyperglycaemic crisis. We included studies in adults and children of all ages in all healthcare settings. Binary logistic regression model was used to explore the effect of various demographic and biochemical parameters variables on patient's final treatment outcome (survival or death). RESULTS Of the 484 papers that were identified, 68 articles were included in the systematic review and meta-analysis (54 case report, 10 case series, and 4 cohort studies). Studies involving 639 DKA patients with confirmed SARS-CoV-2 [46 (7.2%) were children and 334 (52.3%) were adults] were analyzed. The median or mean patient age ranged from < 1 years to 66 years across studies. Most of the patients (n = 309, 48.3%) had pre-existing type 2 diabetes mellitus. The majority of the patients were male (n = 373, 58.4%) and belonged to Hispanic (n = 156, 24.4%) and black (n = 98, 15.3%) ethnicity. The median random blood glucose level, HbA1c, pH, bicarbonate, and anion gap in all included patients at presentation were 507 mg/dl [IQR 399-638 mg/dl], 11.4% [IQR 9.9-13.5%], 7.16 [IQR 7.00-7.22], 10 mmol/l [IQR 6.9-13 mmol/l], and 24.5 mEq/l [18-29.2 mEq/l]; respectively. Mortality rate was [63/243, 25.9%], with a majority of death in patients of Hispanic ethnicity (n = 17, 27%; p = 0.001). The odd ratios of death were significantly high in patients with pre-existing diabetes mellitus type 2 [OR 5.24, 95% CI 2.07-15.19; p = 0.001], old age (≥ 60 years) [OR 3.29, 95% CI 1.38-7.91; p = 0.007], and male gender [OR 2.61, 95% CI 1.37-5.17; p = 0.004] compared to those who survived. CONCLUSION DKA is not uncommon in SARS-CoV-2 patients with diabetes mellitus and results in a mortality rate of 25.9%. Mortality key determinants in DKA patients with SARS-CoV-2 infection are individuals with pre-existing diabetes mellitus type 2, older age [≥ 60 years old], male gender, BMI ≥ 30, blood glucose level > 1000 mg/dl, and anion gap ≥ 30 mEq/l.
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Affiliation(s)
- Saad Alhumaid
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Al-Ahsa, 31982 Saudi Arabia
| | - Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia
- College of Nursing, Princess Norah Bint Abdul Rahman University, Riyadh, Saudi Arabia
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Zainab Al Alawi
- Division of Allergy and Immunology, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Ali A. Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, 11533 Saudi Arabia
- Department of Public Health and Nutrition, The University of Haripur, Haripur, 22610 Pakistan
| | | | - Sadiq A. Al Salman
- Division of Neurology, Internal Medicine Department, King Fahad Hofuf Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Ahmed S. Al-Alawi
- Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Rashdiah Street, P. O. Box 12944, Al-Ahsa, 31982 Saudi Arabia
| | - Mohammed H. Al Hassan
- Administration of Nursing, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Hesham Alhamad
- Regional Medical Supply, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Mustafa A. Al-kamees
- Primary Care Medicine, Al-Ahsa Health Cluster, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Fawzi M. Almousa
- Department of Pharmacy, Al Jaber Hospital for Eye, Ear, Nose and Throat, Al-Ahsa, Saudi Arabia
| | - Hani N. Mufti
- Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- Department Cardiac Sciences, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
- Department of Medical Research, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Ali M. Alwesabai
- Department of Restorative Dentistry, King Faisal General Hospital, Ministry of Health, Al-Ahsa, Saudi Arabia
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Uttar Pradesh, Izatnagar, Bareilly, 243122 India
| | - Jaffar A. Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Awad Al-Omari
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
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Abstract
Racism- a system operating at the intrapersonal, interpersonal, institutional, and structural levels- is a serious threat to the health and wellbeing of children and adolescents. This narrative review highlights racism as a social determinant of health, and describes how racism breeds disparate pediatric health outcomes in infant health, asthma, Type 1 diabetes, mental health, and pediatric surgical conditions. Key examples include the association of residential racial segregation and the alarming infant mortality rate among Black infants as well as the role of redlining and discriminatory housing practices on asthma morbidity among Black children and adolescents. Furthermore, inequitable care practices such as (1) racial and ethnic disparities in insulin pump usage in patients with Type 1 diabetes, (2) lower rates pharmacotherapy initiation in racialized children with mental health disorders, and (3) decreased pain medication management and confirmatory imaging in Black children with acute appendicitis, highlight the role of interpersonal racism in propagating poor health outcomes. An urgent call to action is needed to address pediatric health inequities and ensure all children can live healthy lives. Key strategies must tackle racism at the individual, institutional, and structural levels and include building a diverse workforce, prioritizing research to describe the impact of racism on pediatric health outcomes, initiating improvement efforts to close equity gaps, building community partnerships, co-designing solutions alongside patients and families, and advocating for policy change to address the social conditions that impact children and adolescents of color.
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Affiliation(s)
- Meghan Fanta
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 5018, Cincinnati, OH 45229, USA
| | - Deawodi Ladzekpo
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ndidi Unaka
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. MLC 5018, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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Abdulhussein FS, Chesser H, Boscardin WJ, Gitelman SE, Wong JC. Youth with Type 1 Diabetes Had Improvement in Continuous Glucose Monitoring Metrics During the COVID-19 Pandemic. Diabetes Technol Ther 2021; 23:684-691. [PMID: 34042523 PMCID: PMC8573792 DOI: 10.1089/dia.2021.0131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: The impact of the coronavirus disease-2019 (COVID-19) pandemic on glycemic metrics in children is uncertain. This study evaluates the effect of the shelter-in-place (SIP) mandate on glycemic metrics in youth with type 1 diabetes (T1D) using continuous glucose monitoring (CGM) in Northern California, United States. Methods: CGM and insulin pump metrics in youth 3-21 years old with T1D at an academic pediatric diabetes center were analyzed retrospectively. Data 2-4 months before (distant pre-SIP), 1 month before (immediate pre-SIP), 1 month after (immediate post-SIP), and 2-4 months after (distant post-SIP) the SIP mandate were compared using paired t-tests, linear regression, and longitudinal analysis using a mixed effects model. Results: Participants (n = 85) had reduced mean glucose (-10.3 ± 4.4 mg/dL, P = 0.009), standard deviation (SD) (-5.0 ± 1.3 mg/dL, P = 0.003), glucose management indicator (-0.2% ± 0.03%, P = 0.004), time above range (TAR) >250 mg/dL (-3.5% ± 1.7%, P = 0.01), and increased time in range (TIR) (+4.7% ± 1.7%, P = 0.0025) between the distant pre-SIP and distant post-SIP periods. Relationships were maintained using a mixed effects model, when controlling for other demographic variables. There was improvement in SD, TAR 180-250 mg/dL, and TIR for participants with private insurance, but changes in the opposite direction for participants with public insurance. Conclusions: Improvement in CGM metrics in youth with T1D during the COVID-19 pandemic suggests that diabetes management can be maintained in the face of sudden changes to daily living. Youth with public insurance deserve more attention in research and clinical practice.
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Affiliation(s)
- Fatema S. Abdulhussein
- Division of Endocrinology, Department of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Hannah Chesser
- Division of Endocrinology, Department of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - W. John Boscardin
- Department of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Stephen E. Gitelman
- Division of Endocrinology, Department of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Jenise C. Wong
- Division of Endocrinology, Department of Pediatrics, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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Abstract
This article summarizes clinical observations and management strategies in pediatric type 1 diabetes (T1D) during the coronavirus disease 2019 (COVID-19) pandemic. Despite initial fears that children with diabetes would, similar to adults with diabetes, be at risk for severe COVID-19, most pediatric patients with a history of T1D who developed COVID-19 had mild disease or were asymptomatic similar to their peers without diabetes. The article also summarizes the use of telemedicine to provide ongoing care for pediatric patients with T1D during the COVID-19 pandemic. Finally, the article highlights important lessons learned about management of pediatric diabetes during the COVID-19 pandemic.
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40
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Abstract
Diabetes disproportionably affects minorities in the United States. Substantial disparities exist in diabetes incidence, glycemic control, complications, mortality, and management. The most important biologic contributors to diabetes disparities are obesity, insulin resistance, and inadequate glycemic control. Providers and health systems must also recognize the behavioral, social, and environmental factors that promote and sustain racial/ethnic differences in diabetes and its complications. Metformin and sodium-glucose cotransporter 2 inhibitors are the most convenient drugs for treatment of diabetes in minority patients. Multilevel interventions at the patient, provider, health system, community, and policy levels are needed to reduce diabetes disparities in high-risk groups.
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Affiliation(s)
- Nasser Mikhail
- Endocrinology Division, Department of Medicine, Olive View-UCLA Medical Center, David-Geffen-UCLA School of Medicine, Sylmar, CA 91342, USA
| | - Soma Wali
- Department of Medicine, Olive View-UCLA Medical Center, David-Geffen-UCLA School of Medicine, Sylmar, CA 91342, USA
| | - Arleen F Brown
- Department of Medicine, Olive View-UCLA Medical Center, David-Geffen-UCLA School of Medicine, Sylmar, CA 91342, USA.
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41
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Barrett CE, Park J, Kompaniyets L, Baggs J, Cheng YJ, Zhang P, Imperatore G, Pavkov ME. Intensive Care Unit Admission, Mechanical Ventilation, and Mortality Among Patients With Type 1 Diabetes Hospitalized for COVID-19 in the U.S. Diabetes Care 2021; 44:1788-1796. [PMID: 34158365 PMCID: PMC9109617 DOI: 10.2337/dc21-0604] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether risk of severe outcomes among patients with type 1 diabetes mellitus (T1DM) hospitalized for coronavirus disease 2019 (COVID-19) differs from that of patients without diabetes or with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS Using the Premier Healthcare Database Special COVID-19 Release records of patients discharged after COVID-19 hospitalization from U.S. hospitals from March to November 2020 (N = 269,674 after exclusion), we estimated risk differences (RD) and risk ratios (RR) of intensive care unit admission or invasive mechanical ventilation (ICU/MV) and of death among patients with T1DM compared with patients without diabetes or with T2DM. Logistic models were adjusted for age, sex, and race or ethnicity. Models adjusted for additional demographic and clinical characteristics were used to examine whether other factors account for the associations between T1DM and severe COVID-19 outcomes. RESULTS Compared with patients without diabetes, T1DM was associated with a 21% higher absolute risk of ICU/MV (RD 0.21, 95% CI 0.19-0.24; RR 1.49, 95% CI 1.43-1.56) and a 5% higher absolute risk of mortality (RD 0.05, 95% CI 0.03-0.07; RR 1.40, 95% CI 1.24-1.57), with adjustment for age, sex, and race or ethnicity. Compared with T2DM, T1DM was associated with a 9% higher absolute risk of ICU/MV (RD 0.09, 95% CI 0.07-0.12; RR 1.17, 95% CI 1.12-1.22), but no difference in mortality (RD 0.00, 95% CI -0.02 to 0.02; RR 1.00, 95% CI 0.89-1.13). After adjustment for diabetic ketoacidosis (DKA) occurring before or at COVID-19 diagnosis, patients with T1DM no longer had increased risk of ICU/MV (RD 0.01, 95% CI -0.01 to 0.03) and had lower mortality (RD -0.03, 95% CI -0.05 to -0.01) in comparisons with patients with T2DM. CONCLUSIONS Patients with T1DM hospitalized for COVID-19 are at higher risk for severe outcomes than those without diabetes. Higher risk of ICU/MV in patients with T1DM than in patients with T2DM was largely accounted for by the presence of DKA. These findings might further guide recommendations related to diabetes management and the prevention of COVID-19.
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Affiliation(s)
- Catherine E Barrett
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA .,COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Joohyun Park
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - James Baggs
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yiling J Cheng
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Meda E Pavkov
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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42
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Noor N, Ebekozien O, Levin L, Stone S, Sparling DP, Rapaport R, Maahs DM. Diabetes Technology Use for Management of Type 1 Diabetes Is Associated With Fewer Adverse COVID-19 Outcomes: Findings From the T1D Exchange COVID-19 Surveillance Registry. Diabetes Care 2021; 44:e160-e162. [PMID: 34385347 DOI: 10.2337/dc21-0074] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/12/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Nudrat Noor
- Quality Improvement and Population Health, T1D Exchange, Boston, MA
| | - Osagie Ebekozien
- Quality Improvement and Population Health, T1D Exchange, Boston, MA.,University of Mississippi Medical Center, Jackson, MS
| | - Laura Levin
- Lurie Children Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sheri Stone
- State University of New York Upstate Medical University, Syracuse, NY
| | - David P Sparling
- Harold Hamm Diabetes Center, University of Oklahoma College of Medicine, Oklahoma City, OK
| | | | - David M Maahs
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA
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43
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Ruan Y, Ryder REJ, De P, Field BCT, Narendran P, Iqbal A, Gandhi R, Harris S, Nagi D, Aziz U, Karra E, Ghosh S, Hanif W, Edwards AE, Zafar M, Dashora U, Várnai KA, Davies J, Wild SH, Wilmot EG, Webb D, Khunti K, Rea R. A UK nationwide study of people with type 1 diabetes admitted to hospital with COVID-19 infection. Diabetologia 2021; 64:1717-1724. [PMID: 33966090 PMCID: PMC8106514 DOI: 10.1007/s00125-021-05463-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/23/2021] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. METHODS A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. RESULTS Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55-74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. CONCLUSIONS/INTERPRETATION In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. IN PEOPLE WITH TYPE 1 DIABETES AND COVID-19 ADMITTED TO HOSPITAL IN THE UK, BMI AND ONE OR MORE MICROVASCULAR COMPLICATIONS HAD A POSITIVE ASSOCIATION AND LOW SERUM CREATINE LEVELS HAD A NEGATIVE ASSOCIATION WITH DEATH/ADMISSION TO INTENSIVE CARE UNIT AFTER ADJUSTING FOR AGE.
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Affiliation(s)
- Yue Ruan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Robert E J Ryder
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Parijat De
- Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Benjamin C T Field
- Department of Clinical & Experimental Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
- Department of Diabetes & Endocrinology, Surrey & Sussex Healthcare NHS Trust, Redhill, Surrey, UK
| | - Parth Narendran
- Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ahmed Iqbal
- Department of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rajiv Gandhi
- Department of Diabetes & Endocrinology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sophie Harris
- Diabetes and Endocrinology Department, King's College Hospital, London, UK
| | - Dinesh Nagi
- Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield, UK
| | | | | | - Sandip Ghosh
- Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wasim Hanif
- Diabetes Centre, The Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amy E Edwards
- Department of Diabetes and Endocrinology, Newham University Hospital, Barts Health NHS Trust, London, UK
| | | | | | - Kinga A Várnai
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jim Davies
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Department of Computer Science, University of Oxford, Oxford, UK
| | - Sarah H Wild
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Emma G Wilmot
- Diabetes Department, University Hospitals of Derby and Burton NHS FT, Derby, UK
- University of Nottingham, Nottingham, UK
| | - David Webb
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, UK
| | - Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Oxford NIHR Biomedical Research Centre, Oxford, UK.
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Alonso GT, Ebekozien O, Gallagher MP, Rompicherla S, Lyons SK, Choudhary A, Majidi S, Pinnaro CT, Balachandar S, Gangat M, Curda Roberts AJ, Marks BE, Creo A, Sanchez J, Seeherunvong T, Jimenez‐Vega J, Patel NS, Wood JR, Gabriel L, Sumpter KM, Wilkes M, Rapaport R, Cymbaluk A, Wong JC, Sanda S, Albanese‐O'neill A. Diabetic ketoacidosis drives COVID-19 related hospitalizations in children with type 1 diabetes. J Diabetes 2021; 13:681-687. [PMID: 33855813 PMCID: PMC8251108 DOI: 10.1111/1753-0407.13184] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/22/2021] [Accepted: 04/11/2021] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Diabetes is a risk factor for poor COVID-19 outcomes, but pediatric patients with type 1 diabetes are poorly represented in current studies. METHODS T1D 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. RESULTS Data from 266 patients with previously established type 1 diabetes aged <19 years with COVID-19 were reported. Diabetic ketoacidosis (DKA) was the most common adverse outcome (n = 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 = 61) were more likely than nonhospitalized patients (n = 205) to have minority race/ethnicity (67% vs 39%, P < 0.001), public insurance (64% vs 41%, P < 0.001), higher A1c (11% [97 mmol/mol] vs 8.2% [66 mmol/mol], P < 0.001), and lower insulin pump and lower continuous glucose monitoring use (26% vs 54%, P < 0.001; 39% vs 75%, P < 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. CONCLUSIONS Higher A1c remained the only predictor for hospitalization with COVID-19. Diabetic ketoacidosis is the primary concern among this group.
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Affiliation(s)
| | | | | | | | - Sarah K. Lyons
- Texas Children's HospitalBaylor College of MedicineHoustonTexasUSA
| | | | - Shideh Majidi
- Barbara Davis CenterUniversity of ColoradoAuroraColoradoUSA
| | | | | | - Mariam Gangat
- Rutgers‐Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | | | - Brynn E. Marks
- Children's National HospitalGeorge Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
| | - Ana Creo
- Mayo ClinicRochesterMinnesotaUSA
| | - Janine Sanchez
- Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Jose Jimenez‐Vega
- Helen DeVos Children's HospitalMichigan State University College of Human MedicineGrand RapidsMichiganUSA
| | - Neha S. Patel
- Milton S. Hershey Medical Center, PennState HealthHersheyPennsylvaniaUSA
| | - Jamie R. Wood
- UH Rainbow Babies & Children's HospitalCase Western Reserve UniversityClevelandOhioUSA
| | - Liana Gabriel
- Hassenfeld Children's Hospital at NYU LangoneNew YorkNew YorkUSA
| | - Kathryn M. Sumpter
- University of Tennessee Health Science CenterLe Bonheur Children's Hospital MemphisMemphisTennesseeUSA
| | | | | | - Anna Cymbaluk
- Texas Children's HospitalBaylor College of MedicineHoustonTexasUSA
| | - Jenise C. Wong
- Madison Clinic for Pediatric DiabetesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Srinath Sanda
- Madison Clinic for Pediatric DiabetesUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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45
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Weinstock RS, Prahalad P, Rioles N, Ebekozien O. T1D Exchange Quality Improvement Collaborative: A Learning Health System to Improve Outcomes for All People With Type 1 Diabetes. Clin Diabetes 2021; 39:251-255. [PMID: 34421199 PMCID: PMC8329012 DOI: 10.2337/cd21-0032] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Majidi S, Ebekozien O, Noor N, Lyons SK, McDonough R, Gandhi K, Izquierdo R, Demeterco-Berggren C, Polsky S, Basina M, Desimone M, Thomas I, Rioles N, Jimenez-Vega J, Malik FS, Miyazaki B, Albanese-O’Neill A, Jones NHY. Inequities in Health Outcomes in Children and Adults With Type 1 Diabetes: Data From the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2021; 39:278-283. [PMID: 34421203 PMCID: PMC8329009 DOI: 10.2337/cd21-0028] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Health care inequities among racial and ethnic groups remain prevalent. For people with type 1 diabetes who require increased medical access and care, disparities are seen in access to care and health outcomes. This article reports on a study by the T1D Exchange Quality Improvement Collaborative evaluating differences in A1C, diabetic ketoacidosis (DKA), severe hypoglycemia, and technology use among racial and ethnic groups. In a diverse cohort of nearly 20,000 children and adults with type 1 diabetes, A1C was found to differ significantly among racial and ethnic groups. Non-Hispanic Blacks had higher rates of DKA and severe hypoglycemia and the lowest rate of technology use. These results underscore the crucial need to study and overcome the barriers that lead to inequities in the care and outcomes of people with type 1 diabetes.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center, University of Colorado, Aurora, CO
| | | | | | - Sarah K. Lyons
- Baylor College of Medicine/Texas Children’s Hospital, Houston, TX
| | | | - Kajal Gandhi
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
| | | | | | - Sarit Polsky
- Barbara Davis Center, University of Colorado, Aurora, CO
| | - Marina Basina
- Stanford University School of Medicine, Stanford, CA
| | | | - Inas Thomas
- C.S. Mott Children’s Hospital, Ann Arbor, MI
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Michalakis K, Ilias I. COVID-19 and hyperglycemia/diabetes. World J Diabetes 2021; 12:642-650. [PMID: 33995851 PMCID: PMC8107977 DOI: 10.4239/wjd.v12.i5.642] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/26/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
In early studies regarding coronavirus disease 2019 (COVID-19), type 2 diabetes mellitus was considered to contribute substantially to the disease’s inflammatory response. Subsequently, even hyperglycemia, regardless of insulin resistance or diabetes mellitus, was found to be additionally harmful. Recent studies have shown inflammation of the pancreatic β cells in COVID-19, even leading to new onset diabetes mellitus. We hereby summarize core literature on glycemia and COVID-19, and present implicated pathways and mechanisms.
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Affiliation(s)
| | - Ioannis Ilias
- Department of Endocrinology, Diabetes and Metabolism, Elena Venizelou Hospital, Athens GR-11521, Greece
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McKee AM, Al-Hammadi N, Hinyard LJ. Disparities in Utilization and Outcomes With Continuous Subcutaneous Insulin Infusion in Young Adults With Type 1 Diabetes. Endocr Pract 2021; 27:769-775. [PMID: 33991655 DOI: 10.1016/j.eprac.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate which factors determine utilization patterns and outcomes of continuous subcutaneous insulin infusion (CSII) in young adults with type 1 diabetes. METHODS Utilizing the Optum deidentified electronic health record data set between 2008 to 2018 to perform a retrospective cohort study, we identified 2104 subjects with type 1 diabetes aged 18 to 30 years. We evaluated the effect of race on determining CSII utilization, HbA1c (%), and hospital admission for diabetic ketoacidosis (DKA). Crude and adjusted estimates were computed using logistic regression and linear mixed models. RESULTS There was low CSII utilization among individuals who were Black, Hispanic, male, and those with governmental insurance. These groups also demonstrated higher HbA1c levels. Subjects who were Black, Hispanic, and those with governmental insurance had higher odds of DKA. Even when commercially insured, Black and Hispanic subjects demonstrated higher HbA1c levels, and Black individuals had higher odds of DKA. CONCLUSION In a large electronic health record database in the U.S., there was low CSII utilization overall, particularly in Black and Hispanic minorities, despite CSII showing superior HbA1c control without an increase in DKA events.
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Affiliation(s)
- Alexis M McKee
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
| | - Noor Al-Hammadi
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Institute, Saint Louis University, St. Louis, Missouri
| | - Leslie J Hinyard
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Institute, Saint Louis University, St. Louis, Missouri
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Type 1 Diabetes Mellitus in the SARS-CoV-2 Pandemic: Oxidative Stress as a Major Pathophysiological Mechanism Linked to Adverse Clinical Outcomes. ANTIOXIDANTS (BASEL, SWITZERLAND) 2021; 10:antiox10050752. [PMID: 34065123 PMCID: PMC8151267 DOI: 10.3390/antiox10050752] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023]
Abstract
Recent reports have demonstrated the association between type 1 diabetes mellitus (T1DM) and increased morbidity and mortality rates during coronavirus disease (COVID-19) infection, setting a priority of these patients for vaccination. Impaired innate and adaptive immunity observed in T1DM seem to play a major role. Severe, life-threatening COVID-19 disease is characterized by the excessive release of pro-inflammatory cytokines, known as a "cytokine storm". Patients with T1DM present elevated levels of cytokines including interleukin-1a (IL), IL-1β, IL-2, IL-6 and tumor necrosis factor alpha (TNF-α), suggesting the pre-existence of chronic inflammation, which, in turn, has been considered the major risk factor of adverse COVID-19 outcomes in many cohorts. Even more importantly, oxidative stress is a key player in COVID-19 pathogenesis and determines disease severity. It is well-known that extreme glucose excursions, the prominent feature of T1DM, are a potent mediator of oxidative stress through several pathways including the activation of protein kinase C (PKC) and the increased production of advanced glycation end products (AGEs). Additionally, chronic endothelial dysfunction and the hypercoagulant state observed in T1DM, in combination with the direct damage of endothelial cells by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may result in endothelial and microcirculation impairment, which contribute to the pathogenesis of acute respiratory syndrome and multi-organ failure. The binding of SARS-CoV-2 to angiotensin converting enzyme 2 (ACE2) receptors in pancreatic b-cells permits the direct destruction of b-cells, which contributes to the development of new-onset diabetes and the induction of diabetic ketoacidosis (DKA) in patients with T1DM. Large clinical studies are required to clarify the exact pathways through which T1DM results in worse COVID-19 outcomes.
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