Study looks at type I diabetes and COVID-19

By Dr. Ananya Mandal, MDJun 10 2020

Researchers from the United States have analyzed the information on type I diabetics and COVID-19. Their study titled, "Type 1 Diabetes and COVID-19: Preliminary Findings From a Multicenter Surveillance Study in the U.S.," is published in the latest issue of the journal Diabetes Care.

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What was the study about?

The researchers explained that the Centers for Disease Control and Prevention (CDC) says that people with diabetes are likely to be severely affected by infections. Due to the current pandemic of COVID-19, these individuals remain at a higher risk of not only being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but also having poorer health outcomes. One of the reasons behind such raised risk includes poor control of blood sugar, they wrote. Severe fall in blood sugar or hypoglycemia could also be a cause of this heightened risk of SARS-CoV-2 infection, they wrote.

The researchers say that there is limited evidence regarding the outcome of type I diabetics in COVID-19. They wrote that this is the first multi-center American study that looks at this population with the infection. The study was undertaken thus to "examine patient characteristics and adverse outcomes among patients with type 1 diabetes with confirmed COVID-19." They also looked at the outcomes of patients with COVID-19 like symptoms who were not confirmed cases of the infection.

What was done?

This was a T1D Exchange Quality Improvement Collaborative (T1DX-QI) study, including data from 49 endocrinology clinics from 64 different sites across the U.S. Detailed medical history of all the participants were recorded for the study. They had all tested positive for COVID-19 on nasopharyngeal swabs, throat swabs, sputum samples, etc. using RT-PCR test. As per CDC, the patients had symptom profiles including one or more such as "fever, cough, shortness of breath, myalgia, runny nose, sore throat, headache, nausea or vomiting, abdominal pain, diarrhea." All the participant's exposure to COVID-19 among household contacts was recorded. Participants were given a 33-item questionnaire via the Qualtrics survey tool.

What was found?

The data was gathered up until the 5^th of May 2020, and the researchers looked at the medical history of  COVID-19–positive and COVID-19–like patients who had symptoms of the disease but were not confirmed yet.

COVID-19 confirmed patients

There were 33 patients in the COVID-19 positive group, of which 63.6 percent were females, and 36.4 percent were non-Hispanic white. The average age was 24.8 years, and median glycosylated hemoglobin (a marker for long term blood sugar control) was 8.5 percent.

Some of the common presenting symptoms among these COVID-19 positive patients were;

• High blood glucose (48.5%)
• Fever or elevated temperature (45.5%)
• Dry cough (39.4%)
• Excess fatigue (33.3%)
• Vomiting (33.3%)
• Shortness of breath (30.3%)
• Nausea (30.2%)
• Body ache or headaches (21.2%)
• Less than 15 percent of patients developed "chills, chest pain, loose stools, abdominal pain, loss of taste, and loss of smell."

Among the COVID-19 positive patients, obesity was the most common comorbid condition seen in 39.4 percent of cases. High blood pressure was seen in 12.1 percent. Regarding the outcome of the patients, diabetic ketoacidosis (DKA), was the most typical complication seen in 45.5 percent.

COVID-19-like patients or those who had symptoms but the infection could not be confirmed

Thirty-one patients belonged to this category. Of these, 51.8 percent were females, and 61.3 percent were non-Hispanic whites. The average age of these patients was 16.8 years, and median HbA1c was 8 percent. One of the most prevalent complications in this group was also DKA seen in 13.3 percent.

The symptomatology among these patients was similar to those who had tested positive for the infection. These were;

• High blood glucose (56.7%)
• Fever/elevated temperature (36.7%)
• Dry cough (36.7%)
• Nausea (33.3%)
• Body aches or headaches (33.3%)
• Excess fatigue (23.3%)
• Shortness of breath (23.3%)

Conclusions and implications

The authors write that this is a preliminary report with a small number (total 64) of type I diabetic patients. They noted that the most frequent presentations of these patients, seen in over 50 percent, was high blood sugar. Nearly one-third of the patients developed DKA. They call for further studies that would understand the risk factors that determine the clinical course of COVID-19 infection among type I diabetes patients. They also point out that the average age of those affected with the infection while being type I diabetic was lower, and thus detailed adult, as well as pediatric studies, are needed. The outcomes of these patients and the best possible therapeutic options also need in-depth detailed studies.