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

Background: Patient outcomes of COVID-19 have improved throughout the pandemic. However, because it is not known whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time, we investigated differences in COVID-19 outcomes for patients with T1D in the United States. Methods: We analyzed data collected via a registry of patients with T1D and COVID-19 from 56 sites between April 2020 and January 2021. We grouped cases into first surge (April 9, 2020, to July 31, 2020, n=188) and late surge (August 1, 2020, to January 31, 2021, n=410), and then compared outcomes between both groups using descriptive statistics and logistic regression models. Results: Adverse outcomes were more frequent during the first surge, including diabetic ketoacidosis (32% vs 15%, P<.001), severe hypoglycemia (4% vs 1%, P=.04), and hospitalization (52% vs 22%, P<.001). Patients in the first surge were older (28 [SD,18.8] years vs 18.0 [SD, 11.1] years, P<.001), had higher median hemoglobin A1c levels (9.3 [interquartile range {IQR}, 4.0] vs 8.4 (IQR, 2.8), P<.001), and were more likely to use public insurance (107 [57%] vs 154 [38%], P<.001). The odds of hospitalization for adults in the first surge were 5 times higher compared to the late surge (odds ratio, 5.01;95% CI, 2.11-12.63). Conclusion: Patients with T1D who presented with COVID-19 during the first surge had a higher proportion of adverse outcomes than those who presented in a later surge. Keywords: TD1, diabetic ketoacidosis, hypoglycemia.