Mary Pat Gallagher, MD, of NYU Langone Health, explains her research documenting new onset diabetes and diabetic ketoacidosis (DKA) throughout the COVID-19 pandemic.
During the COVID-19 pandemic, patients with newly diagnosed type 1 diabetes were much more likely to be in severe diabetic ketoacidosis, said Mary Pat Gallagher, MD, a pediatric endocrinologist at NYU Langone Health. Gallagher's talk, "Epidemiology of COVID-19 and Pediatric Diabetes—New-Onset/Diabetic Ketoacidosis," was presented at the American Diabetes Association's 81st Scientific Sessions.
Can you introduce yourself and give an overview of your work?
My name is Mary Pat Gallagher and I'm a pediatric endocrinologist at NYU Langone in New York City. I am the director of the pediatric diabetes center at Hassenfeld Children's Hospital at NYU Langone. We have an interdisciplinary center here that does clinical research and provides interdisciplinary clinical care.
How did you carry out your research on the epidemiology of COVID-19 and pediatric diabetes?
Early in the COVID-19 pandemic, we had heard from our colleagues around the world, particularly in Italy, where type 1 diabetes (T1D) is very common. In fact, Sardinia has the second highest incidence of T1D in the world, second only to Finland. We were hearing what they were seeing in their patients with diabetes. The early reports didn't really separate out T1D versus type 2 diabetes (T2D). We knew that people with diabetes seemed to be disproportionately affected with a more severe form, potentially, of COVID-19. But we weren't sure if that was specific to a type of diabetes, or specific to people of a certain age, or people who had other comorbidities like hypertension, or renal failure, and things like that. Even before we had the first case that was reported in the United States, we were talking to our colleagues around the country about how we should collect data and how we should approach this pandemic in the United States. I was fortunate to connect with the T1D Exchange. They were very interested as well, in trying to track how this pandemic was affecting people with T1D. Unlike some of the European countries, we don't have a national registry that makes that easy to do. So we knew that we wanted to set something up in advance of seeing the cases here in the United States, which is what we did. We set up the T1D Exchange COVID-19 registry and about, I think, 47 different centers around the United States submitted cases to the registry, to let us get some insight into what they were seeing.
Because it was a registry, we know we missed cases, because early in the pandemic, especially in New York City, which was kind of the epicenter in the United States at the beginning of the pandemic here, we know we didn't test most people who had COVID-19 symptoms, because we were only testing people who were hospitalized. We recognized that this was only a partial view of what was happening, but we also recognized the most severe cases were unlikely to go unreported. So we felt that we would get a general sense of the hospitalization rate, the intensive care unit rate, the fatality rate in the T1D population, as opposed to the hospitalized patients, at least in the beginning, and then later in larger populations, as compared to the general population.
What were the main findings regarding new onset diabetes and diabetic ketoacidosis (DKA)?
What we found was consistent with what was reported from other registries around the world, that people with T1D, being newly diagnosed, so who had not previously been diagnosed with diabetes. We saw that they presented in a much more severe state of metabolic disarray. Yes, they were in DKA but not only were they in DKA, they were much more likely to be in what's considered severe DKA with a pH of 7.1 or less.