Older adults with type 1 diabetes more likely to be hospitalized for COVID-19 than youths
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Adults with type 1 diabetes are significantly more likely to be hospitalized if they contract COVID-19 compared with children, according to a study published in the Journal of Clinical Endocrinology & Metabolism.
In an analysis of people with type 1 diabetes with confirmed COVID-19, adults aged 40 years or older were about 4.2 times more likely to be hospitalized compared with youths aged 18 years and younger.
“Age older than 40 years is a risk factor for patients with type 1 diabetes and COVID-19, with children and younger adults experiencing milder disease and better prognosis,” Carla Demeterco-Berggren, MD, PhD, director of quality in the diabetes clinic at Rady Children’s Hospital San Diego, and associate clinical professor of pediatrics in the division of pediatric endocrinology at the University of California, San Diego, told Healio. “Public health recommendations, including wearing masks and vaccinating, need to be followed by all to reduce risk of contracting COVID-19.”
Demeterco-Berggren and colleagues conducted a cross-sectional study of people with type 1 diabetes and confirmed COVID-19 from April 2020 to March 2021 at 56 endocrinology sites in the U.S. Data were obtained from 44 pediatric sites and 12 adult sites. Hospitalization for COVID-19 included ICU admission or inpatient care. Nonhospitalized patients were those seen in outpatient clinics or the ED or receiving care at home. The study was sponsored and coordinated by the T1D Exchange Quality Improvement Collaborative.
Older adults more likely to be hospitalized
The study cohort of 767 people with type 1 diabetes and COVID-19 (mean age, 22.4 years; 52% female) was divided into three age groups: 18 years and younger (n = 415), 19 to 40 years (n = 247) and older than 40 years (n = 105). The oldest group had a higher proportion of patients hospitalized for COVID (47%) vs. those aged 18 years and younger (20%) and adults aged 19 to 40 years (16%; P < .001). Of adults older than 40 years, 28% had an adverse outcome, such as death, diabetic ketoacidosis or severe hypoglycemia, compared with 21% of children and 17% of those aged 19 to 40 years (P < .001).
After adjusting for sex, HbA1c, race and ethnicity, insurance type and comorbidities, adults older than 40 years were significantly more likely to be hospitalized for COVID-19 compared with patients aged 18 years and younger (adjusted OR = 4.2; 95% CI, 2.28-7.83). There was no significant difference for adverse outcomes between the age groups.
“Our data align with previous evidence suggesting that hospitalization is infrequent in children and young adults, rising after age 40 years,” Demeterco-Berggren said. “It has been previously reported that people with type 1 diabetes and COVID-19 have a higher probability of hospitalization than patients without diabetes, with age being the most important factor.”
Hospitalization more likely for minorities
The likelihood for hospitalization was higher for all participants with higher HbA1c (OR = 1.46; 95% CI, 1.35-1.58; P < .001). Non-Hispanic Black and Hispanic patients and those from other ethnicities were more likely to be hospitalized than white patients (OR = 3.46; 95% CI, 2.42-4.99; P < .001). The presence of comorbidities was associated with an increased risk for hospitalization (OR = 3.09; 95% CI, 2.15-4.47; P < .001). The odds for developing adverse outcomes were also increased for people with higher HbA1c (OR = 1.5; 95% CI, 1.37-1.66; P < .001), people who were non-Hispanic Black, Hispanic, or another non-Hispanic white ethnicity (OR = 3.31; 95% CI, 2.17-5.09; P < .001) and those with comorbidities (OR = 1.61; 95% CI, 1.07-2.44; P < .05).
Demeterco-Berggren said more studies involving multicenter collaborations are crucial to understanding how age and modifiable risk factors impact COVID-19 prognosis to prevent and reduce adverse outcomes for people with type 1 diabetes.
For more information:
Carla Demeterco-Berggren, MD, PhD, can be reached at cdemeterco@rchsd.org.
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