Abstract: Factors associated with hospitalization in youths and young adults with type 1 diabetes and COVID-19 infection
E. Tallon1, O. Ebekozien2,3, J. Sanchez4, V. Staggs5,6, D. Ferro5, C.-R. Shyu1, M. Clements5
1University of Missouri-Columbia, Institute for Data Science and Informatics, Columbia, USA, 2T1D Exchange, Boston, USA, 3University of Mississippi, School of Population Health, Jackson, USA, 4University of Miami, Miami, USA, 5Children's Mercy Hospital, Kansas City, USA, 6University of Missouri-Kansas City, Kansas City, USA
Introduction: Numerous studies have investigated the impact and increased severity of coronavirus disease 2019 (COVID-19) in adult patients with diabetes. However, findings from older adult patients cannot be generalized to affected children and young adults.
Objectives: In this nationwide retrospective cohort study, we examine whether race/ethnicity and other factors are associated with hospitalization and diabetic ketoacidosis (DKA) in pediatric and young adult patients with type 1 diabetes (T1D) and COVID-19 infection.
Methods: The de-identified COVID-19 patient dataset from the December 2020 release of Cerner Real-World DataTM contains longitudinal data for patients who received care at 87 US-based health systems between December 2019 and September 2020. We used a validated algorithm to identify patients with T1D. Analysis was limited to patients <27 years old with a positive laboratory test or billing code consistent with COVID-19 infection. Generalized linear mixed models were used to examine race/ethnicity, gender, HbA1c, body mass index (BMI), mean blood glucose, age, payer, and Elixhauser comorbidity score (ECS) as correlates of hospital admission and DKA.
Results: In this T1D cohort (n=224), 151 patients (67.4%) were 18-26 years old, and 122 (54.5%) were female. Of these, 41.1% were Hispanic, 30.8% were non-Hispanic White, and 17.4% were non-Hispanic Black. Median HbA1c was 11.1% (IQR 9.0-12.8%). A large majority of patients (65.6%) were hospitalized, and 37.1% of T1D patients were in DKA. In the non-DKA cohort, ECS was associated with hospitalization (OR 1.06 [CI 1.00-1.11], p=0.035), and there was evidence of an association for HbA1c (OR 1.23 [CI 0.99-1.53], p=0.057). Factors associated with DKA included HbA1c (OR 1.41 [CI 1.18-1.69], p<0.001) and public insurance (OR 2.52 [CI 1.01-6.28], p=0.047).
Conclusions: In patients who were not in DKA, higher ECS was associated with hospitalization, while public insurance was significantly associated with DKA for patients who were in DKA.