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.
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.