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Advocacy groups call for including Type 1 diabetes among prioritized vaccine recipients

Advocacy groups call for including Type 1 diabetes among prioritized vaccine recipients
© Aaron Schwartz

Advocacy groups are calling on public health officials to prioritize vaccinating Type 1 diabetes patients in their COVID-19 vaccine distribution plans, citing new research on the risks of serious complications after contracting the virus.

A group of 19 diabetes advocacy organizations recently sent a letter to top CDC officials requesting the federal agency recommend that individuals with Type 1 diabetes be included in prioritized vaccine populations. The CDC sets guidelines for tiered vaccine distribution at the state level which state governments have largely followed.

The guidelines say that people between the ages of 65 and 74 and those between 16 and 64 with underlying medical conditions should receive the COVID-19 vaccine in Phase 1C of the rollout. The underlying medical conditions listed include kidney disease, heart disease and Type 2 diabetes, but not Type 1.

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“The new science leaves little doubt that there should be no distinction between individuals with Type 1 and Type 2 diabetes mellitus, given the common, heightened risk both groups face for the most severe health outcomes of COVID-19,” the groups wrote to the CDC last week.

The CDC did not immediately respond to a request for comment.

Disagreements over who should be included in prioritized groups for the vaccine have stemmed in large part from a limited supply of doses. The federal government recently introduced a policy of not holding back second doses of the Pfizer and Moderna vaccines, instead using all available doses to vaccinate as many people as possible.

Robert Gabbay, the chief scientific and medical officer of the American Diabetes Association, said the group’s concern began when members noticed that new research showed that Type 1 diabetes carried at least the same risks associated with the novel coronavirus as Type 2 diabetes.

Individuals with Type 1 diabetes are at a 3.3 times higher risk of developing severe illness and are 3.9 times more likely to be hospitalized than those without diabetes, similar to those with Type 2 diabetes, according to the letter to the CDC.

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Gabbay said early on in the pandemic, data was more clear that Type 2 diabetes could lead to serious complications in COVID-19 patients. That was due in part, he said, because of the significantly higher number of people who have Type 2 than Type 1 and also because Type 1 patients are sometimes misclassified as Type 2 when hospitalized.

Of the 34 million Americans with diabetes, almost 1.6 million have Type 1, compared with about 32.6 million with Type 2.

Jennifer Horney, a professor of epidemiology at the University of Delaware, said a reason why Type 1 diabetes may not have been initially considered as an underlying condition is because of the other health effects of Type 2 that have garnered more attention from the medical community.

She said individuals with Type 2 are more likely to also suffer from comorbidities such as obesity and kidney disease, both of which are included as underlying conditions by the CDC.

“The classic example in epidemiology is that people who worked around asbestos were at a higher risk of getting cancer, but people who worked around asbestos and smoked — there was a synergistic effect,” she said. “It’s more than just additive.”

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George Huntley, chief executive officer of both the Diabetes Patient Advocacy Coalition and the Diabetes Leadership Council, said that in addition to signing the CDC letter, his organization has sent more than 1,200 letters to governors and state health department officials to open a second front in the effort to include Type 1 diabetes in the prioritized group.

“We engaged our policy engine, we engaged our collaborative engine and we also engaged the patients to allow their voices to be heard on this issue that’s very important,” Huntley said.

Only four states — Delaware, Ohio, Tennessee and Virginia — consider Type 1 diabetes as an underlying medical condition, Huntley said, adding that updating CDC guidelines would increase the odds of more states adding the disease to their list of prioritized vaccine recipients.

“We hope that the CDC will help with that and get them where they need to be,” said Stewart Perry, vice chair of the Diabetes Leadership Council board. “But we’re going to continue to focus on the states as well as the CDC.”