Black type 1 diabetics disproportionately affected by diabetic ketoacidosis

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According to a recent study, African Americans were more likely to develop diabetic ketoacidosis (DKA), a life-threatening complication of diabetes, prior to and during the novel coronavirus pandemic (COVID-19).

The study, published in the Journal of Clinical Endocrinology and Metabolism, was conducted by researchers at the T1D Exchange Quality Improvement Collaborative in Boston. The study’s scientists aimed to build on previous research which showed disparities in instances of DKA among minorities and better understand how the COVID-19 pandemic impacted rates of DKA among type 1 diabetics (T1D) of different races. According to researchers, DKA, which is a result of insulin deficiency, is an overproduction of acids in the blood that form into ketones. For the study, researchers compared the number of DKA events in children and adults with T1D, documented by seven US medical centers, during March to May of 2020, the first surge of COVID-19, and August to October 2020, the second surge of COVID-19, with the same periods in 2019. Researchers then analyzed the data with descriptive statistics and Chi-square tests.

The results showed no significant difference in the absolute number of DKA events among those with T1D between 2019 and 2020. However, researchers found a significant difference in the percentage of DKA events among non-Hispanic black people and non-Hispanic white people in 2019, which continued throughout the pandemic. In 2019, the data suggested that 45 percent of Black T1Ds experienced DKA while only 16 percent of white T1Ds went into DKA the same year. In 2020, researchers found 49 percent of Black T1Ds, and 19 percent of white T1Ds went into DKA.

“Alarmingly, we found that this disparity in diabetes complications was present even before the COVID-19 pandemic but has not been adequately addressed,” said co-author Osagie Ebekozien, MD, chief medical officer of the T1D Exchange in Boston.

The study also found that T1Ds with continuous glucose monitors and insulin pumps were less likely to go into DKA, however previous studies have shown disparities in accessibility to such devices.

This study revealed how Black T1Ds were disproportionately affected by DKA in both 2019 and 2020, highlighting the fact that disparities within the United State’s healthcare existed prior to the COVID-19 pandemic. According to the study’s authors, this paper underscores the need for better methods of DKA prevention among T1Ds not only during the pandemic but in all instances, especially for those affected by health inequities.