Inequities in Diabetic Ketoacidosis among Patients with Type 1 Diabetes and COVID-19: Data from 52 US Clinical Centers

Osagie Ebekozien*, Shivani Agarwal, Nudrat Noor, Anastasia Albanese-O'Neill, Jenise C. Wong, Tossaporn Seeherunvong, Janine Sanchez, Daniel Desalvo, Sarah K. Lyons, Shideh Majidi, Jamie R. Wood, Runa Acharya, Grazia Aleppo, Kathryn M. Sumpter, Anna Cymbaluk, Nirali A. Shah, Michelle Van Name, Lisa Cruz-Aviles, Guy Todd Alonso, Mary Pat GallagherSrinath Sanda, Alexis Jamie Feuer, Kristina Cossen, Nicole Rioles, Nana Hawa Yayah Jones, Manmohan K. Kamboj, Irl B. Hirsch

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


Objective: We examined whether diabetic ketoacidosis (DKA), a serious complication of type 1 diabetes (T1D) was more prevalent among Non-Hispanic (NH) Black and Hispanic patients with T1D and laboratory-confirmed coronavirus disease 2019 (COVID-19) compared with NH Whites. Method: This is a cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 52 clinical sites in the United States, data were collected from April to August 2020. We examined the distribution of patient factors and DKA events across NH White, NH Black, and Hispanic race/ethnicity groups. Multivariable logistic regression analysis was performed to examine the odds of DKA among NH Black and Hispanic patients with T1D as compared with NH White patients, adjusting for potential confounders, such as age, sex, insurance, and last glycated hemoglobin A1c (HbA1c) level. Results: We included 180 patients with T1D and laboratory-confirmed COVID-19 in the analysis. Forty-four percent (n = 79) were NH White, 31% (n = 55) NH Black, 26% (n = 46) Hispanic. NH Blacks and Hispanics had higher median HbA1c than Whites (%-points [IQR]: 11.7 [4.7], P < 0.001, and 9.7 [3.1] vs 8.3 [2.4], P = 0.01, respectively). We found that more NH Black and Hispanic presented with DKA compared to Whites (55% and 33% vs 13%, P < 0.001 and P = 0.008, respectively). After adjusting for potential confounders, NH Black patients continued to have greater odds of presenting with DKA compared with NH Whites (OR [95% CI]: 3.7 [1.4, 10.6]). Conclusion: We found that among T1D patients with COVID-19 infection, NH Black patients were more likely to present in DKA compared with NH White patients. Our findings demonstrate additional risk among NH Black patients with T1D and COVID-19.

Original languageEnglish (US)
Pages (from-to)E1755-E1762
JournalJournal of clinical endocrinology and metabolism
Issue number4
StatePublished - Apr 1 2021


  • COVID-19
  • DKA
  • inequities
  • type 1 diabetes

ASJC Scopus subject areas

  • Biochemistry, medical
  • Endocrinology
  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology, Diabetes and Metabolism


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