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Comorbidities increase COVID-19 hospitalization in young people with type 1 diabetes

Mann, Elizabeth A; Rompicherla, Saketh; Gallagher, Mary Pat; Alonso, Guy Todd; Fogel, Naomi R; Simmons, Jill; Wood, Jamie R; Wong, Jenise C; Noor, Nudrat; Gomez, Patricia; Daniels, Mark; Ebekozien, Osagie
OBJECTIVES/OBJECTIVE:We evaluated COVID-19 outcomes in children and young adults with type 1 diabetes (T1D) to determine if those with comorbidities are more likely to experience severe COVID-19 compared to those without. RESEARCH DESIGN AND METHODS/METHODS:This cross-sectional study included questionnaire data on patients <25 years of age with established T1D and laboratory-confirmed COVID-19 from 52 sites across the US between April 2020 and October 2021. We examined patient factors and COVID-19 outcomes between those with and without comorbidities. Multivariate logistic regression analysis examined the odds of hospitalization among groups, adjusting for age, HbA1c, race and ethnicity, insurance type and duration of diabetes. RESULTS:Six hundred fifty-one individuals with T1D and COVID-19 were analyzed with mean age 15.8 (SD 4.1) years. At least one comorbidity was present in 31%, and more than one in 10%. Obesity and asthma were the most frequently reported comorbidities, present in 19% and 17%, respectively. Hospitalization occurred in 17% of patients and 52% of hospitalized patients required ICU level care. Patients with at least one comorbidity were almost twice as likely to be hospitalized with COVID-19 than patients with no comorbidities (Odds ratio 2.0, 95% CI: 1.3-3.1). This relationship persisted after adjusting for age, HbA1c, race and ethnicity (minority vs nonminority), insurance type (public vs. private), and duration of diabetes. CONCLUSIONS:Our findings show that comorbidities increase the risk for hospitalization with COVID-19 in children and young adults highlighting the need for tailored COVID-19 prevention and treatment strategies in T1D.
PMID: 36054578
ISSN: 1399-5448
CID: 5332262

Pharmacologic Weight Management in the Era of Adolescent Obesity

Raman, Vandana; Gupta, Anshu; Ashraf, Ambika P; Breidbart, Emily; Gourgari, Evgenia; Kamboj, Manmohan; Kohn, Brenda; Krishnan, Sowmya; Lahoti, Amit; Matlock, Kristal; Mehta, Shilpa; Mistry, Sejal; Miller, Ryan; Page, Laura; Reynolds, Danielle; Han, Joan C
CONTEXT/BACKGROUND:Pediatric obesity is a serious health problem in the United States. While lifestyle modification therapy with dietary changes and increased physical activity are integral for the prevention and treatment of mild to moderate obesity in youth, only a modest effect on sustained weight reduction is observed in children and young adults with severe obesity. This underscores the need for additional evidence-based interventions for children and adolescents with severe obesity, including pharmacotherapy, before considering invasive procedures such as bariatric surgery. EVIDENCE ACQUISITION/METHODS:This publication focuses on recent advances in pharmacotherapy of obesity with an emphasis on medications approved for common and rarer monogenic forms of pediatric obesity. EVIDENCE SYNTHESIS/RESULTS:We review medications currently available in the United States, both those approved for weight reduction in children and "off-label" medications that have a broad safety margin. CONCLUSION/CONCLUSIONS:It is intended that this review will provide guidance for practicing clinicians and will encourage future exploration for successful pharmacotherapy and other interventions for obesity in youth.
PMID: 35932277
ISSN: 1945-7197
CID: 5288432

Visceral adiposity is related to insulin sensitivity and inflammation in adolescents with obesity and mild sleep disordered breathing

Vajravelu, Mary Ellen; Kindler, Joseph M; Zemel, Babette S; Jawad, Abbas; Koren, Dorit; Brar, Preneet; Brooks, Lee J; Reiner, Jessica; Levitt Katz, Lorraine E
OBJECTIVES/OBJECTIVE:To evaluate the relationships between adipose tissue distribution, insulin secretion and sensitivity, sleep-disordered breathing, and inflammation in obese adolescents. METHODS:; non-REM sleep duration), and inflammation (high-sensitivity C-reactive protein, hsCRP). RESULTS:Subjects (55% female) were mean (SD) 14.4 (2.1) years, with BMI Z-score of 2.3 (0.4). AHI was >5 in 10 (18%) subjects and 1< AHI ≤5 in 22 (39%). Visceral adipose tissue area (VAT) was positively correlated with OGTT 1 and 2 h insulin and 1 h glucose, and hsCRP (r=0.3-0.5, p≤0.007 for each). VAT was negatively correlated with sensitivity to insulin (r=-0.4, p=0.005) and SpO2 nadir (r=-0.3, p=0.04) but not with other sleep measures. After adjustment for BMI-Z, sex, population ancestry, age, and sleep measures, VAT remained independently associated with insulin measures and 1 h glucose, but no other measures of glycemia. SAT was not associated with measures of glycemia or insulin resistance. CONCLUSIONS:Among adolescents with obesity, visceral adiposity was associated with insulin resistance, SpO2 nadir, and inflammation. The independent association of visceral adiposity with insulin resistance highlights the potential role of VAT in obesity-related chronic disease.
PMID: 35822712
ISSN: 2191-0251
CID: 5279882

Trends in type 1 diabetic ketoacidosis during COVID-19 surges at seven US centers: highest burden on non-Hispanic Blacks

Lavik, Andrew R; Ebekozien, Osagie; Noor, Nudrat; Alonso, G Todd; Polsky, Sarit; Blackman, Scott M; Chen, Justin; Corathers, Sarah D; Demeterco-Berggren, Carla; Gallagher, Mary Pat; Greenfield, Margaret; Garrity, Ashley; Rompicherla, Saketh; Rapaport, Robert; Yayah Jones, Nana-Hawa
OBJECTIVE:We examined United States (US) trends in diabetic ketoacidosis (DKA) among individuals with type 1 diabetes (T1D) during the COVID-19 pandemic at seven large US medical centers and factors associated with these trends. METHODS:We compared DKA events among children and adults with T1D during COVID-19 surge 1 (March-May 2020) and COVID-19 surge 2 (August-October 2020) to the same periods in 2019. Analysis was performed using descriptive statistics and Chi-square tests. RESULTS:We found no difference in the absolute number of T1D patients experiencing DKA in 2019 vs 2020. However, a higher proportion of non-Hispanic Blacks (NHB) experienced DKA in 2019 than non-Hispanic Whites (NHW) (44.6% vs 16.0%; p<0.001), and this disparity persisted during the COVID-19 pandemic (48.6% vs 18.6%; p<0.001). DKA was less common among patients on continuous glucose monitor (CGM) or insulin pump in 2020 compared to 2019 (CGM: 13.2% vs 15.0%, p<0.001; insulin pump: 8.0% vs 10.6%, p<0.001). In contrast to annual DKA totals, a higher proportion of patients had DKA during COVID-19 surges 1 and 2 compared to the same months in 2019 (surge 1: 7.1% vs 5.4%, p<0.001; surge 2: 6.6% vs 5.7%, p=0.001). CONCLUSIONS:DKA frequency increased among T1D patients during COVID-19 surges with highest frequency among NHB. DKA was less common among patients using CGM or insulin pumps. These findings highlight the urgent need for improved strategies to prevent DKA among patients with T1D-not only under pandemic conditions, but under all conditions-especially among populations most affected by health inequities.
PMID: 35380700
ISSN: 1945-7197
CID: 5204822

Increase in newly diagnosed type 1 diabetes in youth during the COVID-19 pandemic in the US: A multi-center analysis

Wolf, Risa M; Noor, Nudrat; Izquierdo, Roberto; Jett, Destiny; Rewers, Amanda; Majidi, Shideh; Sheanon, Nicole; Breidbart, Emily; Demeterco-Berggren, Carla; Lee, Joyce M; Kamboj, Manmohan K; Ebekozien, Osagie
BACKGROUND:An increase in newly diagnosed type 1 diabetes (T1D) has been posited during the COVID-19 pandemic, but data are conflicting. We aimed to determine trends in newly diagnosed T1D and severity of presentation at diagnosis for pediatric and adolescent patients during COVID-19 (2020) as compared to the previous year (2019) in a multi-center analysis across the United States. METHODS:This retrospective study from seven centers in the T1D Exchange Quality Improvement Collaborative (T1DX-QI) included data on new onset T1D diagnosis and proportion in DKA at diagnosis from January 1 to December 31, 2020, compared to the prior year. Chi-square tests were used to compare differences in patient characteristics during the pandemic period compared to the prior year. RESULTS:Across seven sites, there were 1399 newly diagnosed T1D patients in 2020, compared to 1277 in 2019 (p=0.007). A greater proportion of newly diagnosed patients presented in DKA in 2020 compared to 2019 (599/1399(42.8%) v. 493/1277(38.6%), p=0.02), with a higher proportion presenting with severe DKA (p=0.01) as characterized by a pH<7.1 and/or bicarbonate of <5mmol/L. Monthly data trends demonstrated a higher number of new T1D diagnoses over the spring and summer months (March to September) of 2020 compared to 2019 (p<0.001). CONCLUSIONS:We found an increase in newly diagnosed T1D and a greater proportion presenting in DKA at diagnosis during the COVID-19 pandemic compared to the prior year. Future longitudinal studies are needed to confirm these findings with population level data and determine the long-term impact of COVID-19 on diabetes trends. This article is protected by copyright. All rights reserved.
PMID: 35218124
ISSN: 1399-5448
CID: 5172612

Cardiovascular health in emerging adults with type 1 diabetes

McCarthy, Margaret; Yan, Joeyee; Jared, Mary Christine; You, Erica; Ilkowitz, Jeniece; Gallagher, Mary Pat; Vaughan Dickson, Victoria
AIMS/OBJECTIVE:Individuals with type 1 diabetes (T1D) face increased risk for cardiovascular disease (CVD). Controlling individual cardiovascular risk factors can prevent or slow the onset of CVD. Ideal cardiovascular health is associated with a lower incidence of CVD. Identifying areas of suboptimal cardiovascular health can help guide CVD prevention interventions. To assess cardiovascular health and explore the barriers and facilitators to achieving ideal cardiovascular health in a sample of young adults with T1D. METHODS AND RESULTS/RESULTS:We used a sequential mixed-method design to assess the seven factors of cardiovascular health according to American Heart Association. Qualitative interviews, guided by Pender's Health Promotion Model, were used to discuss participant's cardiovascular health results and the barriers and facilitators to achieving ideal cardiovascular health. We assessed the frequency of ideal levels of each factor. The qualitative data were analysed using content analysis. Qualitative and quantitative data were integrated in the final analysis phase. The sample (n = 50) was majority female (70%), White (86%), with a mean age of 22 ± 2.4 and diabetes duration of 10.7 ± 5.5 years. Achievement of the seven factors of cardiovascular health were: non-smoking (96%); cholesterol <200 mg/dL (76%); body mass index <25 kg/m2 (54%); blood pressure <120/<80 mmHg (46%); meeting physical activity guidelines (38%); haemoglobin A1c <7% (40%); and healthy diet (14%). Emerging qualitative themes related to the perceived benefits of action, interpersonal influences on their diabetes self-management, and perceived self-efficacy. CONCLUSION/CONCLUSIONS:We found areas of needed improvement for cardiovascular health. However, these young adults expressed a strong interest in healthy habits which can be supported by their healthcare providers.
PMID: 34498041
ISSN: 1873-1953
CID: 5088092

Age and Hospitalization Risk in People With Type 1 Diabetes and COVID-19: Data From the T1D Exchange Surveillance Study

Demeterco-Berggren, Carla; Ebekozien, Osagie; Rompicherla, Saketh; Jacobsen, Laura; Accacha, Siham; Gallagher, Mary Pat; Todd Alonso, G; Seyoum, Berhane; Vendrame, Francesco; Haw, J Sonya; Basina, Marina; Levy, Carol J; Maahs, David M
CONTEXT:COVID-19 morbidity and mortality are increased in type 1 diabetes (T1D), but few data focus on age-based outcomes. OBJECTIVE:This work aimed to quantify the risk for COVID-19-related hospitalization and adverse outcomes by age in people with T1D. METHODS:For this observational, multisite, cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 56 clinical sites in the United States, data were collected from April 2020 to March 2021. The distribution of patient factors and outcomes across age groups (0-18, 19-40, and > 40 years) was examined. Descriptive statistics were used to describe the study population, and multivariate logistic regression models were used to analyze the relationship between age, adverse outcomes, and hospitalization. The main outcome measure was hospitalization for COVID-19. RESULTS:A total of 767 patients were analyzed. Fifty-four percent (n = 415) were aged 0 to 18 years, 32% (n = 247) were aged 19 to 40 years, and 14% (n = 105) were older than 40 years. A total of 170 patients were hospitalized, and 5 patients died. Compared to the 0- to 18-years age group, those older than 40 years had an adjusted odds ratio of 4.2 (95% CI, 2.28-7.83) for hospitalization after adjustment for sex, glycated hemoglobin A1c, race, insurance type, and comorbidities. CONCLUSION:Age older than 40 years is a risk factor for patients with T1D and COVID-19, with children and younger adults experiencing milder disease and better prognosis. This indicates a need for age-tailored treatments, immunization, and clinical management of individuals affected by T1D.
PMID: 34581790
ISSN: 1945-7197
CID: 5131202

Differences in COVID-19 Outcomes among Patients with Type 1 Diabetes: First vs Later Surges

Gallagher, Mary Pat; Rompicherla, Saketh; Ebekozien, Osagie; Wilkes, Meredith; Antal, Zoltan; Feuer, Alexis Jamie; Rioles, Nicole; Noor, Nudrat; Gabriel, Liana; O"™Malley, Grenye; Golden, Lauren; Alonso, G. Todd; Ospelt, Emma; Odugbesan, Ori; Lyons, Sarah K.; Mungmode, Ann; Prahalad, Priya; Clements, Mark; Neyman, Anna; Demeterco-Berggren, Carla; Rapaport, Robert
Background: Patient outcomes of COVID-19 have improved throughout the pandemic. However, because it is not known whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time, we investigated differences in COVID-19 outcomes for patients with T1D in the United States. Methods: We analyzed data collected via a registry of patients with T1D and COVID-19 from 56 sites between April 2020 and January 2021. We grouped cases into first surge (April 9, 2020, to July 31, 2020, n = 188) and late surge (August 1, 2020, to January 31, 2021, n = 410), and then compared outcomes between both groups using descriptive statistics and logistic regression models. Results: Adverse outcomes were more frequent during the first surge, including diabetic ketoacidosis (32% vs 15%, P< .001), severe hypoglycemia (4% vs 1%, P= .04), and hospitalization (52% vs 22%, P< .001). Patients in the first surge were older (28 [SD,18.8] years vs 18.0 [SD, 11.1] years, P< .001), had higher median hemoglobin A1c levels (9.3 [interquartile range {IQR}, 4.0] vs 8.4 (IQR, 2.8), P< .001), and were more likely to use public insurance (107 [57%] vs 154 [38%], P< .001). The odds of hospitalization for adults in the first surge were 5 times higher compared to the late surge (odds ratio, 5.01; 95% CI, 2.11-12.63). Conclusion: Patients with T1D who presented with COVID-19 during the first surge had a higher proportion of adverse outcomes than those who presented in a later surge.
ISSN: 1079-6533
CID: 5314772

An endocrine perspective on menstrual suppression for adolescents: achieving good suppression while optimizing bone health

Lahoti, Amit; Yu, Christine; Brar, Preneet Cheema; Dalgo, Austin; Gourgari, Evgenia; Harris, Rebecca; Kamboj, Manmohan K; Marks, Seth; Nandagopal, Radha; Page, Laura; Raman, Vandana; Reynolds, Danielle G; Sarafoglou, Kyriakie; Terrell, Carrie; Stanley, Takara L
Suppression of menstruation and/or ovarian function in adolescent girls may be desired for a variety of reasons. Numerous medical options exist. The choice of the appropriate modality for an individual patient depends on several factors based on differences in the efficacy of achieving menstrual suppression as well as in their side effect profiles. Adolescence is also a period of bone mass accrual in girls, and several of these modalities may negatively influence peak bone mass. This review focuses on the efficacy of achieving menstrual suppression and the effect on bone health of the various options through an overview of the current literature and also highlights areas in need of further research.
PMID: 34388330
ISSN: 2191-0251
CID: 5011502

Hyperosmolar diabetic ketoacidosis-- review of literature and the shifting paradigm in evaluation and management

Brar, Preneet Cheema; Tell, Shoshana; Mehta, Shilpa; Franklin, Bonita
BACKGROUND:Hyperosmolar diabetic ketoacidosis (H-DKA), a distinct clinical entity, is the overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). AIM/OBJECTIVE:We describe the clinical presentation, metabolic aberrations, and associated morbidity/mortality of these cases with H-DKA. We highlight the problem areas of medical care which require particular attention when caring for pediatric diabetes patients presenting with H-DKA. METHODS:In our study we reviewed the literature back to 1963 and retrieved twenty-four cases meeting the criteria of H-DKA: glucose >600 mg/dL, pH < 7.3, bicarbonate <15 mEq/L, and serum osmolality >320 mOsm/kg, while adding three cases from our institution. RESULTS:Average age of presentation of H-DKA was 10.2 years ± 4.5 years in females and 13.3 years ± 4 years in males, HbA1c was 13%. Biochemical parameters were consistent with severe dehydration: serum osmolality = 394.8±55 mOsm/kg, BUN = 48±22 mg/dL, creatinine = 2.81±1.03 mg/dL. Acute kidney injury, present in 12 cases, was the most frequent end-organ complication. CONCLUSION/CONCLUSIONS:Multi-organ involvement with AKI, rhabdomyolysis, pancreatitis, neurological and cardiac issues such as arrhythmias, are common in H-DKA. Aggressive fluid management, insulin therapy and supportive care can prevent acute and long term adverse outcomes in children and adolescents.
PMID: 34731818
ISSN: 1878-0334
CID: 5038192