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Dr Mary Pat Gallagher Discusses the Importance of DKA Mitigation, Finnish T1D Incidence During COVID-19


Mary Pat Gallagher, MD, of NYU Langone Health, outlines why young individuals should be vaccinated against COVID-19 and Finnish data on increased rates of type 1 diabetes (T1D) seen during the pandemic.

Data out of Finland suggest increased incidence of type 1 diabetes may not necessarily be due to infection with SARS-CoV-2—the virus that causes COVID-19—but may have been due to another factor of the pandemic, said Mary Pat Gallagher, MD, a pediatric endocrinologist at NYU Langone Health.


With COVID-19 vaccines approved for teens and children over 12, how might this push to get these populations vaccinated benefit children with diabetes?

I am strongly in support of vaccination against preventable illnesses. I think that it would be advisable for patients to receive the COVID-19 vaccines as soon as the FDA allows it. I think that it is a challenge for our kids under 12, who are unable to be vaccinated currently, who may then have different access to different venues. For instance, there are shows starting to open up and just interactive activities that they might be able to take part in, which right now they're getting frequent nasal swabs to make sure they can continue to participate. But to get back to normal for them, and be able to really participate in school, especially when the summer is over, I really would love for them to be able to be vaccinated, so they could get back to a more normal way of life. And that's not just specific to children with diabetes, it's everyone.

Research shows pandemic mitigation efforts may have led to more cases of diabetic ketoacidosis (DKA) at the time of type 1 diabetes (T1D) diagnosis due in part to parents' COVID-19 exposure concerns. What needs to happen in the future to improve outcomes for these patients should more pandemics occur?

I think that is a big lesson learned from what we saw happen here, and I'm sure diabetes is not the only diagnosis for which this was an issue—that delay in seeking care was a problem. We saw a lot of excess mortality in New York City during the height of the pandemic, and while much of that was probably due to undiagnosed COVID-19 deaths at home, it may also have been excess deaths from cardiac disease from people who didn't go in when they had chest pain or stroke symptoms. It's possible that those people wouldn't have died had they sought care more rapidly.

I think that we have to look at what worked during this pandemic and try not to lose sight of how valuable the ability to see patients virtually is. You can get a lot of information just by looking at a person on camera. You can see if they have any respiratory distress. You can really do more than you think you can in assessing them. I would say that we need to try to make sure that we close the digital divide, because people don't have the same equal access to virtual care. That is an issue, right? First we have to remember it exists and it works really well for certain issues, especially, but it's better than no care 100% of the time. Then we have to try to work on making access to that type of care more widespread.

Do you have any closing thoughts you would like to share?

One of the most interesting pieces of data that has come out is the data from Finland, which has the highest incidence of T1D in the world. There is a strong genetic predisposition to T1D. They documented an actual increase in T1D incidence in their population, which is very interesting because they did not have a very significant incidence of SARS-CoV-2 infection. They did some seroprevalence studies—which we're not sure how to interpret, in all fairness—but it was extremely low in the newly diagnosed patients. So it suggests that there may be some other phenomenon that did occur in the same period, but that this increase in frequency—so not just the incidence of DKA at diagnosis, but the increase in diagnosis of diabetes, T1D—that it might be related to something other than a personal infection with SARS-CoV-2, but in some way related to other things that were going on during the pandemic. It's fascinating, I think.

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