A number of studies published in the past few months suggest that people with type 1 and type 2 diabetes are at roughly the same increased risk of hospitalization and death due to COVID-19.
If anything, type 1 diabetics may be a little more susceptible.
As part of the current launch of the vaccine in Massachusetts, phase 2 diabetics can receive the COVID-19 vaccine. Type 1 diabetics are expected to wait until April with the rest of the public.
That has advocates for those with the chronic condition affected.
“Lives are at stake,” said Robert Gabbay, a Boston-based doctor who serves as the scientific and medical director of the American Diabetes Association and who has sent letters to Governor Charlie Baker’s administration expressing concern.
Currently, the Baker administration follows the guidelines of the Centers for Disease Control and Prevention, which classify the far more common type 2 diabetes among the 12 underlying diseases that individuals are at “increased risk” for hospitalization and exposure to COVID-19 Deaths are exposed.
As part of the state vaccine rollout, Massachusetts residents with two or more of these conditions, ranging from cancer to obesity, will be in the second group in phase 2, which can enroll for vaccination along with people over the age of 65. Individuals with only one of these conditions are part of the fourth group in phase 2.
Type 1 diabetics do not qualify, which means they have until phase three, when the rollout opens to the general public, unless they qualify for an early priority for some other reason.
The CDC lists type 1 diabetes among the diseases that are at increased risk of complications due to COVID-19. According to Gabbay, the early research did not provide clear evidence that type 1 diabetes was an increased risk.
However, a number of studies published in the past six months suggest that type 1 diabetics are equally, if not more, susceptible to COVID-19 than those with type 2.
One study found that people in England with type 1 diabetes were 3.5 times more likely to die in hospital compared to people without diabetes, while type 2 diabetics were twice as likely. Another found that people with type 1 diabetes had 3.9 times the risk of hospitalization and 3.35 times the risk of greater disease severity, “which was similar to the risk of type 2 diabetes “. A third study of patients hospitalized in Scotland with COVID-19 found that the risk of hospitalization or death was more than twice as high in type 1 diabetics and less than in those with type 2 diabetes 1.5 times higher.
On January 13, the ADA directed a letter to the CDC in which the more recent data “convincingly demonstrate” the increased risk for people with type 1 diabetes.
“As we have all experienced, the history of COVID has evolved. And now we have new data and now we are smarter. So we have to respond by saying that people with type 1 diabetes are at the same risk and should therefore be given priority, ”Gabbay said in an interview with Boston.com. “All people with diabetes should be prioritized.”
So far, however, the CDC guidelines have not changed. That hasn’t stopped some states like Tennessee and New York from adding type 1 diabetes to their list of prioritized diseases. UK officials do not distinguish between the two types either.
However, the Baker administration has not followed suit.
The ADA has sent letters to Baker, Health Commissioner Monica Bharel, and the COVID-19 state vaccine advisory group urging them to give priority to type 1 diabetics. Based on ADA data, there are approximately 50,000 people diagnosed with type 1 diabetes in Massachusetts (the organization doesn’t have specific numbers, but says the state has 507,000 people with both types; an estimated 10 percent of all diabetes cases are type 1).
Baker’s Office did not respond to requests for comment specifically on diabetes, but the governor has expressed his general openness to tweaking the state’s list of prioritized conditions.
The government is also facing calls for asthma, another condition not included in CDC guidelines, to be prioritized when the vaccine is introduced. When asked about adding asthma, Baker told reporters Wednesday that it was “a very important issue”.
“It’s not in line with CDC guidelines, but it’s something we’re definitely talking about,” he said.
Gabbay hopes to bring type 1 diabetes to the fore too.
“Nationally there are 1.6 million people with type 1 diabetes,” he said. “Some of them will likely get COVID without vaccination, a subset of them will be hospitalized, and another subset, sadly, as we know, will die.”
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