Abstract: Risk Factors for Hyperglycemic and Hyperketotic Emergencies in COVID+ Youth with Type 1 Diabetes (T1D)
Sarah Tsai, Erin M. Tallon, Diana Ferro, Erica Zarse, David D. Williams, Chi Ren Shyu, Mark A. Clements
Recent studies report increased frequency of hyperglycemic and hyperketotic emergencies in youth with T1D and coronavirus disease 20 (COVID-19) . Morbidity and mortality risk may be increased in individuals who develop diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) with concurrent COVID-infection.
Using a Cerner RealWorld DataTM COVID-dataset with de-identified information from 490,373 individuals with COVID- (12/2019-9/2020) from 87 U.S. healthcare systems, we examined demographic and clinical characteristics of youth with established T1D and suspected or confirmed COVID-infection. We then used generalized mixed models to evaluate the association of body mass index (BMI) , race and ethnicity, and hemoglobin A1c (HbA1c) to two outcomes: (1) DKA and (2) concurrent DKA and HHS (DKA+HHS) . We used a validated cohort selection algorithm to identify 383 youth (<18 years old; 50.7% female) with T1D. Of these, 35.8% were non-Hispanic White, 27.4% were Hispanic, and 14.9% were non-Hispanic Black/Other (NHB/O) . The most common comorbid conditions were fluid and electrolyte disorders, documented for 64.2% of the cohort. Other frequent comorbid conditions included cardiac arrhythmias (19.3%) , chronic pulmonary disease (17.2%) , and depression (16.2%) . Thirty-nine percent of youths in the cohort experienced DKA only, 1.0% experienced HHS only, and 4.2% experienced DKA+HHS. After adjustment, we found HbA1c to be the only factor associated with increased odds of DKA alone (adjusted odds ratio [AOR]: 1.22; 95% CI (1.09,1.36) ; p<0.001) . Odds of DKA+HHS were markedly increased in NHB/O individuals (AOR: 4.47; 95% CI (1.07,18.72) ; p=0.04) .
Demographic and clinical care factors that associate with increased risk of DKA or DKA+HHS differ among youth with T1D and COVID-infection. Whether risk factors associated with DKA, HHS or DKA+HHS differ among youth with T1D with or without COVID-infection requires further study.
Disclosure
S.Tsai: Stock/Shareholder; Dexcom, Inc. E.M.Tallon: None. D.Ferro: None. E.Zarse: None. D.D.Williams: None. C.Shyu: n/a. M.A.Clements: Consultant; Glooko, Inc., Research Support; Abbott Diabetes, Dexcom, Inc.