TY - JOUR
T1 - Diabetic ketoacidosis drives COVID-19 related hospitalizations in children with type 1 diabetes
AU - Alonso, Guy Todd
AU - Ebekozien, Osagie
AU - Gallagher, Mary Pat
AU - Rompicherla, Saketh
AU - Lyons, Sarah K.
AU - Choudhary, Abha
AU - Majidi, Shideh
AU - Pinnaro, Catherina T.
AU - Balachandar, Sadana
AU - Gangat, Mariam
AU - Curda Roberts, Alissa Jeanne
AU - Marks, Brynn E.
AU - Creo, Ana
AU - Sanchez, Janine
AU - Seeherunvong, Tossaporn
AU - Jimenez-Vega, Jose
AU - Patel, Neha S.
AU - Wood, Jamie R.
AU - Gabriel, Liana
AU - Sumpter, Kathryn M.
AU - Wilkes, Meredith
AU - Rapaport, Robert
AU - Cymbaluk, Anna
AU - Wong, Jenise C.
AU - Sanda, Srinath
AU - Albanese-O'neill, Anastasia
N1 - Funding Information:
The Leona M. and Harry B. Helmsley Charitable Trust funds the T1D Exchange QI Collaborative. The T1D Exchange received partial financial support for this study from Abbott Diabetes, Dexcom, Medtronic, Insulet Corporation, JDRF, Eli Lilly, and Tandem Diabetes Care. None of the sponsors were involved in initiating, designing, or preparing the manuscript for this study.
Funding Information:
The Leona M. and Harry B. Helmsley Charitable Trust funds the T1D Exchange QI Collaborative. The T1D Exchange received partial financial support for this study from Abbott Diabetes, Dexcom, Medtronic, Insulet Corporation, JDRF, Eli Lilly, and Tandem Diabetes Care. None of the sponsors were involved in initiating, designing, or preparing the manuscript for this study.
Publisher Copyright:
© 2021 Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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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U2 - 10.1111/1753-0407.13184
DO - 10.1111/1753-0407.13184
M3 - Article
C2 - 33855813
AN - SCOPUS:85109232352
SN - 1753-0393
VL - 13
SP - 681
EP - 687
JO - Journal of Diabetes
JF - Journal of Diabetes
IS - 8
ER -