Diabetic Ketoacidosis Disproportionately Affecting Black Patients with Type 1 Diabetes

A new study from the T1D Exchange details the increased likelihood of Black patients with type 1 diabetes experiencing diabetic ketoacidosis during the COVID-19 pandemic, regardless of whether or not they had COVID-19.

An analysis comparing data from children and adults with type 1 diabetes prior to the pandemic against data from 2 different periods during the pandemic, results indicate there was no difference in the absolute number of patients with type 1 diabetes experiencing diabetic ketoacidosis in 2019 compared to 2020, but also shed light on disparities seen in the rate of diabetic ketoacidosis both before and during the pandemic among non-Hispanic Black patients compared to their White counterparts.

“Our work shows racial inequities in diabetes care were present before the pandemic, starkly visible during the pandemic, and will continue to persist after the pandemic—unless we systemically root out and target racial inequities in diabetes care,” said Andrew R. Lavik, MD, PhD, of the Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio, in a statement from the Endocrine Society.

Aggregating data from 7 US medical centers, investigators designed the current study to provide clinicians with insight into potential disparities in trends of diabetic ketoacidosis among individuals with type 1 diabetes during the pandemic according to race/ethnicity. These medical centers collected data on diabetic ketoacidosis events among adults and children with type 1 diabetes during 2020 and was compared against data from the same period in 2019. For the purpose of analysis, investigators created a pair of COVID-19 time periods, which were classified as COVID-19 surge 1 and COVID-19 surge 2, with surge 1 pertaining to the period lasting from March-May 2020 and surge 2 pertaining to the period lasting from August-October 2020.

From the medical centers included in the study, investigators obtained data related to 15,267 patients with type 1 diabetes who received treatment in 2019 and 15,176 patients with type 1 diabeteswho received treatment in 2020. Initial analysis indicated there were no year-to-year differences in the total number of patients with diabetic ketoacidosis or within-race differences in diabetic ketoacidosis by race/ethnicity.

Further analysis indicated a greater proportion of non-Hispanic Black individuals experienced diabetic ketoacidosis in 2019 than their non-Hispanic White counterparts (44.6% vs 16.0%, P <.001). Investigators pointed out this apparent disparity persisted during the pandemic, with non-Hispanic Black individuals accounting for 48.6% of cases of diabetic ketoacidosis against 18.6% for non-Hispanic White individuals (P <.001).

Results of the investigators’ analyses indicated diabetic ketoacidosis was less common among those using CGM or an insulin pump in 20202 compared to 2019 (CGM: 13.2% vs 15.0%, P <.001; insulin pump: 8.0% vs 10.6%, P <.001). Investigators also pointed out a higher proportion of patients had diabetic ketoacidosis during surge 1 and surge 2 of the COVID-19 pandemic compared to the same months in 2019 (surge 1: 7.1% vs 5.4%, P <.001; surge 2: 6.6% vs 5.7%, P=.001).

“Minorities continue to be affected by life-threatening yet preventable complications of diabetes more than other groups. We must redouble our efforts to relieve this burden, both during the COVID-19 pandemic and beyond,” added senior investigator Nana-Hawa Yayah Jones, MD, also of Cincinnati Children’s, in the aforementioned statement.

This study, “Trends in Type 1 Diabetic Ketoacidosis During COVID-19 Surges at Seven US Centers: Highest Burden on Non-Hispanic Black Patients,” was published in the Journal of Clinical Endocrinology and Metabolism.