COMMENTARY

Off to College With T1D in the COVID Era: How to Prepare

Anne L. Peters, MD

Disclosures

September 04, 2020

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This transcript has been edited for clarity.

Today I'm going to discuss the return to school this fall. There are two scenarios I want to talk about. The first is young adults with type 1 diabetes (T1D) who are leaving home and going off to college. They have their own set of risks and concerns. Second are parents who have T1D whose young kids are going back to school.

There's much concern about what is the right approach for people without diabetes, but it's especially important to talk about people who have diabetes or have someone in their family with diabetes.

People who have well-controlled diabetes (an A1c of around 7 or less) don't necessarily do worse if they develop COVID-19. But there are other risk factors that can be in the mix. Things that worsen outcomes include obesity, cardiovascular disease, hypertension, renal disease, and age. These are all comorbidities that increase risk.

If you have a young, healthy individual under the age of 50 with an A1c of 7 or less, and they don't have any other comorbidities, that person is probably not at higher risk of doing badly with COVID-19 than anybody else.

However, people with T1D can develop ketosis if they stop eating or drinking fluids. With COVID-19, people often don't feel like eating or drinking as much, particularly if they lose their sense of taste and smell. People with T1D need to be sure to test their ketones.

The College-bound Kid With T1D

Let's start with the college-aged kid with T1D. We obviously want our kids to go to college and have the whole college experience, but I'd prefer that they not get COVID-19. Simple precautions to minimize the risk for exposure are important: having a private dorm room, not living in a place with many other people, not going to parties. All of those things are easy to say but hard to get young people to do.

We need to help prepare our college-aged patients. They need to have urine ketone test strips. They should have carbohydrate-containing fluids on hand — Pedialyte, Gatorade, whatever they like. They should do their best not to get infected, but if they do, they need to have access to student health or to someone who can be there for them, and then they'll be quarantined for 2 weeks.

During this quarantine period, parents may want to race over to be near their child. Of course, they really can't be with their child who is now quarantined with COVID-19. Odds are, if their kid's diabetes is well controlled, that young adult is going to be fine.

We know that not every young adult is under good control, and they may need extra help or extra care. I certainly wouldn't dissuade parents from going and staying at a hotel nearby to help if they want to, but they need to realize that they're not going to be able to directly contact their child unless something terrible happens. Parents can be nearby if it makes them feel better, but in general, young people are going to be fine if they develop COVID-19.

Another consideration, though, is that when these college kids come home, they may need to quarantine for up to 14 days before they interact with other family members. This is particularly true of older family members (above the age of 65) or family members with significant comorbidities who are at home.

Parents With T1D and School-aged Kids

The second question I am getting asked often is about parents who have young children. The parents have diabetes; the kids do not. The kids want to go back to school; the parents want the kids to go back to school. I know that there's been a lot of agony over this. Every state seems to be different, and even every school district has different rules about what this is going to look like come fall.

Each family needs to assess their risks. Again, if somebody has well-controlled diabetes and lacks those comorbidities that I discussed earlier, it's probably okay to slightly increase their risk of getting COVID-19 by sending their child back to school. But obviously they should try to do what they can to prevent the spread of COVID-19. If there are older people in the family, they need to be segregated in some way so that they're not likely to increase their risk of getting COVID-19.

It's a family decision. Many of my families are having their kids go back to school in some way or another. I do think it's safe, even though it does increase the risk slightly, and for many individuals it's a reasonable decision.

One absolute for all families is to go and get the flu shot. Everybody should have the flu shot this year and, frankly, should be up-to-date on all of their vaccines in order to reduce the risk of getting other illnesses in addition to COVID-19.

Speak to patients about their own family's situation, about their individual risk if they're the person with diabetes and any other comorbidities. Remind them to prepare with fluids, insulin, ketone test strips, and supplies needed in order to quarantine and keep safe and healthy. Finally, encourage them to get their flu shots.

I hope that keeps everyone safe and doing well. Thank you very much.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts, and three books, on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

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