COVID-19 Hospitalization in Adults with Type 1 Diabetes: Results from the T1D Exchange Multicenter Surveillance Study

Context Diabetes mellitus is associated with increased COVID-19 morbidity and mortality, but there are few data focusing on outcomes in people with type 1 diabetes. Objective The objective of this study was to analyze characteristics of adults with type 1 diabetes for associations with COVID-19 hospitalization. Design An observational multisite cross-sectional study was performed. Diabetes care providers answered a 33-item questionnaire regarding demographics, symptoms, and diabetes- and COVID-19-related care and outcomes. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between glycated hemoglobin (HbA1c), age, and comorbidities and hospitalization. Setting Cases were submitted from 52 US sites between March and August 2020. Patients or Other Participants Adults over the age of 19 with type 1 diabetes and confirmed COVID-19 infection were included. Interventions None. Main Outcome Measures Hospitalization for COVID-19 infection. Results A total of 113 cases were analyzed. Fifty-eight patients were hospitalized, and 5 patients died. Patients who were hospitalized were more likely to be older, to identify as non-Hispanic Black, to use public insurance, or to have hypertension, and less likely to use continuous glucose monitoring or insulin pumps. Median HbA1c was 8.6% (70 mmol/mol) and was positively associated with hospitalization (odds ratio 1.42, 95% confidence interval 1.18-1.76), which persisted after adjustment for age, sex, race, and obesity. Conclusions Baseline glycemic control and access to care are important modifiable risk factors which need to be addressed to optimize care of people with type 1 diabetes during the worldwide COVID-19 pandemic.

Automated summary

Diabetes mellitus, especially type 1, has been linked to higher morbidity and mortality in COVID-19 cases. This study analyzed characteristics of adults with type 1 diabetes to identify factors associated with COVID-19 hospitalization. Older age, non-Hispanic Black ethnicity, public insurance, hypertension, lower use of continuous glucose monitoring or insulin pumps, and higher HbA1c levels were found to be associated with higher likelihood of hospitalization. Improved glycemic control and access to care are crucial in optimizing care for type 1 diabetes patients during the COVID-19 pandemic.