Since almost the start of the COVID-19 pandemic, it’s been clear that people with type 2 diabetes face a much higher risk of serious illness and death if they develop the viral infection. But it has also become increasingly evident that people with type 1 diabetes face a similar or even higher level of risk, depending on the study and how you interpret the numbers.
Still, there haven’t been as many studies looking at COVID-19 and type 1 diabetes as there have been for type 2. This has led to the Centers for Disease Control and Prevention (CDC) prioritizing people with type 2 in its current recommendations for who gets access to COVID-19 vaccines — guidance that many people with type 1 find puzzling and dismissive.
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Serious health risks with illness in type 1
As noted in an article at Stat about the CDC’s vaccine guidelines and diabetes, those guidelines — last updated in late December — state that people with type 2 diabetes “are at increased risk” for severe illness if they develop COVID-19, while people with type 1 “might be at an increased risk” for severe illness. As a result, people with type 2 are included in Phase 1 of the vaccine rollout, after healthcare workers and people who live in long-term care facilities.
People with type 1, on the other hand, are included in Phase 2 of the vaccine rollout, based on what the CDC deems to be “limited evidence” of an increased risk for severe illness. The problem with this guidance, according to many people with type 1 and organizations that represent them, is that the evidence actually isn’t all that limited — and other health agencies, such as the ones creating vaccine guidelines for Britain and the state of Tennessee, have come to the conclusion that people with diabetes should all be part of the same risk category.
JDRF, the leading type 1 diabetes research and advocacy organization, urges the CDC to include people with type 1 in the earlier phase of the vaccine rollout, and believes that the agency hasn’t adequately taken the latest studies into consideration. Those studies include one published in August 2020 in the journal Lancet Diabetes & Endocrinology, which found that compared with similar people without diabetes who were hospitalized for COVID-19, people with type 2 were over twice as likely to die, while those with type 1 were over 3.5 times as likely to die.
Another study, published in December 2020 in the journal Diabetes Care, found that people with either type 1 or type 2 diabetes who develop COVID-19 are three to four times as likely to experience severe illness and hospitalization as people without diabetes.
And as shown in a study published in January 2021 in the Journal of Clinical Endocrinology & Metabolism, Black and Hispanic people with type 1 who develop COVID-19 are at especially high risk for developing diabetic ketoacidosis, a dangerous complication in which a lack of available insulin results in high blood glucose and the breakdown of stored fat for energy.
Watching and waiting for updated guidelines
The CDC is constantly revisiting its guidelines on priority groups for COVID-19 vaccines, and it’s possible that the agency will decide to group people with diabetes together as a high-priority group at some point in the near future. In the meantime, state and local agencies in charge of implementing vaccination programs have the power to create their own rules about who should have access to COVID-19 vaccines — and can prioritize all people with diabetes if they choose to do so.
Many doctors are also asking for the ability to prioritize certain patients with diabetes — both type 1 and type 2 — based on a history of diabetic ketoacidosis or other factors that would put them at increased risk of severe illness if they develop COVID-19.
For now, though, most people with diabetes have no choice but to wait their turn as the U.S. vaccine rollout — which has so far been much slower than anticipated — ramps up in the coming months.