Diabetes Care | 2021
Diabetes Technology Use for Management of Type 1 Diabetes Is Associated With Fewer Adverse COVID-19 Outcomes: Findings From the T1D Exchange COVID-19 Surveillance Registry
Abstract
People with coronavirus disease 2019 (COVID-19) and preexisting type 1 diabetes (T1D) are at high risk of diabetesrelated outcomes such as diabetic ketoacidosis (DKA) and hospitalization (1). For people with elevated glucose levels, infections could further exacerbate the risk of acute complications. As part of the management of T1D, the use of diabetes technology including continuous glucose monitors (CGM) and insulin pumps is recommended to improve glycemic control (2). However, despite increasing evidence of the benefits of diabetes technology, its uptake remains low, in part owing to systemic racism and social inequities, including in diabetes and device education, patient motivation, and peer support (3,4). The aim of this article is to examine the association of technology use and clinical outcomes during the COVID-19 pandemic. We analyzed data from the T1DX COVID-19 Surveillance Registry, a U.S.based multicenter study for people with T1D, to examine the frequency of adverse outcomes across categories of technology use. The registry details have previously been described; briefly, all participating sites completed a chart review and via an online questionnaire submitted information on all patients with T1D at their sites who tested positive for COVID-19 (1,2). This analysis included 447 people with T1D and laboratory-confirmed COVID-19 infection during March 2020–December 2020. Patients were grouped into four categories of diabetes technology use: “no device use,” including patients who did not report using a CGM or insulin pump device; “CGM use,” including all patients currently using a CGM device, regardless of insulin pump use; “insulin pump use,” including all patients currently using an insulin pump, regardless of CGM device; and “CGM and insulin pump use,” including patients who reported using a CGM in combination with an insulin pump. Adverse outcomes including hospitalization, DKA, severe hypoglycemia, or death were reported through medical chart review. Patients who were hospitalized or admitted to an intensive care unit were classified as hospitalized patients, whereas patients who received home care, or were seen at the clinic or emergency department, were grouped under the category of home care. DKA was defined as the presence of 1) hyperglycemia (blood glucose >11 mmol/L), 2) venous pH <7.3 or serum bicarbonate <15 mmol/L, and 3) ketonomenia or ketonuria. Diabetes technology use differed across race/ethnicity; non-Hispanic (NH) White individuals used CGM devices significantly more than NH Black and Hispanic individuals (67% vs. 10% and 16%, respectively; P < 0.01) (Fig. 1A). The rates of hospitalization and DKA were lower among all device users, including the subgroup that used CGM only (N = 85) (18% and 13%) and insulin pump only (N = 25) (12% and 12%), compared with rates among nonusers (61% and 36%, P < 0.01) (Fig. 1B). Further, the odds of hospitalization among nonusers of technology were higher compared with the odds for those using any device after adjustment for age, insurance status, and race/ethnicity (odds ratio 6.1 [95% CI 3.7–10.1]). Additionally, the odds of DKA among nonusers of technology were also higher