Full Inequities in Diabetic Ketoacidosis among Patients with Type 1 diabetes and COVID-19: Data from 52 US Clinical Centers.

We examined whether diabetic ketoacidosis (DKA), a serious complication of type 1 diabetes (T1D) was more prevalent among Non-Hispanic (NH) Black and Hispanic patients with T1D and laboratory-confirmed COVID-19 compared to NH Whites.This is a cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 52 clinical sites in the US, data was collected April - August 2020. We examined the distribution of patient factors and DKA events across NH White, NH Black, and Hispanic race/ethnicity groups. Multivariable logistic regression analysis was performed to examine the odds of DKA among NH Black and Hispanic patients with T1D as compared to NH White patients, adjusting for potential confounders, such as age, sex, insurance, and last HbA1c.We included 180 patients with T1D and laboratory-confirmed COVID-19 in the analysis. Forty-four percent (n=79) were NH White, 31% (n=55) NH Black, 26% (n=46) Hispanic. NH Blacks and Hispanics had higher median HbA1c than Whites ((%-points) [IQR]:11.7[4.7], p<0.001, and 9.7[3.1] vs. 8.3[2.4], p=0.01). We found that more NH Black and Hispanic presented with DKA compared to Whites (55% and 33% vs. 13%, p<0.001 and p=0.008, respectively). After adjusting for potential confounders, NH Black patients continued to have greater odds of presenting with DKA compared with NH Whites (OR [95%CI]: 3.7 [1.4,10.6]).We found that among T1D patients with COVID-19 infection, NH Blacks were more likely to present in DKA compared with NH White patients. Our findings demonstrate additional risk among NH Blacks with T1D and COVID-19.

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