A few weeks ago, Diabetes Québec released a position statement about the prioritization of people with diabetes in the immunization plan. The organization asked the INSPQ to revise its list of prioritized groups for vaccination (available in French only), and stressed that people with any type of diabetes, regardless of their age, are at a higher risk of complications from COVID-19 and should therefore be higher up on the priority list. The American Diabetes Association (ADA) and JDRF Canada published a similar statement. So, what is the supporting data?
Recent studies on people with type 1 diabetes (T1D) and their risk of complications
In the early days of the pandemic, there was little evidence that people with T1D developed more serious cases of COVID-19, such as cases requiring hospitalization. While early research was primarily done on type 2 diabetes (T2D), we now have more data on T1D and COVID-19 to help us paint a better picture.
It was noted that the absolute risk (i.e., total number of people with T1D) of hospitalization and serious complications remains low. There are still very few serious cases of COVID-19 among people with T1D. This is mostly due to the fact that people with T1D account for only 10% of people with diabetes, and they are younger on average than people with T2D. Older age and overweight are two factors that are more prevalent in people with T2D and strongly associated with a higher risk of developing a serious case of COVID-19.
But some studies have found that the relative risk (i.e., as compared to the total number of people without diabetes) of serious complications is comparable among both people with T1D and people with T2D. In truth, according to these studies, the risk of serious complications is close to three times higher among people with any type of diabetes (including T1D) as opposed to people without diabetes. People with a higher HbA1c (glycemic average) and comorbidities (high blood pressure, obesity, etc.) are the most affected.
A call for fast-tracked vaccination
In short, recent studies have shown that people with T1D are among those at a higher risk for developing a serious case of COVID-19. Therefore, they should be prioritized for vaccination.
Keep in mind that even though the risk of complications from COVID-19 is higher among people with any type of diabetes, the percentage of ICU hospitalizations and death remains low. For instance, a person without diabetes may be exposed to a 0.1% risk of complications while a person of the same age with T1D would be exposed to a 0.3% risk.
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- McGurnaghan, S.J., Weir, A., Bishop, J., et al. (2020). Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland, The Lancet Diabetes & Endocrinology. https://doi.org/10.1016/S2213-8587(20)30405-8
- Tucker, M. (2021). Pressure Builds on CDC to Prioritize Both Diabetes Types for Vaccine. Retrieved January 19, 2021, from https://www.medscape.com/viewarticle/944111?src=WNL_mdpls_210115_mscpedit_diab&uac=39049BJ&spon=22&impID=2986010&faf=1
- Prise de position sur la priorisation des adultes vivant avec le diabète pour la vaccination contre la COVID-19. (2020). Retrieved January 19, 2021, from https://www.diabete.qc.ca/fr/actualites/nouvelles/prise-de-position-sur-la-priorisation-des-adultes-vivant-avec-le-diabete-pour-la-vaccination-contre-la-covid-19/
- Gregory, J.M., Slaughter, J.C., Duffus, S.H., et al. (2020). COVID-19 Severity Is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic’s Impact in Type 1 and Type 2 Diabetes, Diabetes Care. DOI: 10.2337/dc20-226
- Vaccins contre la COVID-19 et diabète de type 1 (DT1). (n.d.). Retrieved January 22, 2021, from https://www.frdj.ca/blogue/vaccins-contre-la-covid-19-et-diabete-de-type-1-dt1/