COVID-19 Hospitalization in Adults with Type 1 Diabetes: Results from the T1D Exchange Multi-Center Surveillance Study

O’Malley, Grenye; Ebekozien, Osagie; Desimone, Marisa; Pinnaro, Catherina T; Roberts, Alissa; Polsky, Sarit; Noor, Nudrat; Aleppo, Grazia; Basina, Marina; Tansey, Michael; Steenkamp, Devin; Vendrame, Francesco; Lorincz, Ilona; Mathias, Priyanka; Agarwal, Shivani; Golden, Lauren; Hirsh, Irl B; Levy, Carol J

CONTEXT: Diabetes mellitus is associated with increased COVID-19 morbidity and mortality, but there is little data focusing on outcomes in people with type 1 diabetes. OBJECTIVE: The objective of this study was to analyze characteristics of adults with type 1 diabetes for associations with COVID-19 hospitalization. DESIGN: An observational multi-site cross-sectional study was performed. Diabetes providers answered a 33-item questionnaire regarding demographics, symptoms, and diabetes- and COVID-19-related care and outcomes. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between HbA1c, age, and comorbidities and hospitalization. SETTING: Cases were submitted from 52 US sites between March and August 2020. PATIENTS OR OTHER PARTICIPANTS: Adults over the age of 19 with type 1 diabetes and confirmed COVID-19 infection were included. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Hospitalization for COVID-19 infection. RESULTS: A total of 113 cases were analyzed. Fifty-eight patients were hospitalized, and five patients died. Patients who were hospitalized were more likely to be older, to identify as non-Hispanic Black, to use public insurance, or to have hypertension, and less likely to use continuous glucose monitoring or insulin pumps. Median HbA1c was 8.6% (70 mmol/mol) and was positively associated with hospitalization (OR 1.42, 95% CI 1.18-1.76), which persisted after adjustment for age, sex, race, and obesity. CONCLUSIONS: Baseline glycemic control and access to care are important modifiable risk factors which need to be addressed to optimize care of people with type 1 diabetes during the worldwide COVID-19 pandemic.