Pressure Builds on CDC to Prioritize Both Diabetes Types for Vaccine

Miriam E. Tucker

January 14, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The American Diabetes Association (ADA), along with 18 other organizations, has sent a letter to the US Centers for Disease Control and Prevention (CDC) urging them to rank people with type 1 diabetes as equally high-risk for COVID-19 severity, and therefore vaccination, as those with type 2 diabetes.

On January 12, the CDC recommended states vaccinate all Americans over age 65 and those with underlying health conditions that make them more vulnerable to COVID-19.

Currently, type 2 diabetes is listed among 12 conditions that place adults "at increased risk of severe illness from the virus that causes COVID-19," with the latter defined as "hospitalization, admission to the intensive care unit, intubation or mechanical ventilation, or death."

On the other hand, the autoimmune condition type 1 diabetes is among 11 conditions the CDC says "might be at increased risk" for COVID-19, but limited data were available at the time of the last update on December 23, 2020.

"States are utilizing the CDC risk classification when designing their vaccine distribution plans. This raises an obvious concern as it could result in the approximately 1.6 million with type 1 diabetes receiving the vaccination later than others with the same risk," states the ADA letter, sent to the CDC on January 13.

Representatives from the Endocrine Society, American Association of Clinical Endocrinology, Pediatric Endocrine Society, Association of Diabetes Care & Education Specialists, and JDRF, among others, cosigned the letter.

Newer Data Show Those With Type 1 Diabetes at Equally High Risk

While acknowledging that "early data did not provide as much clarity about the extent to which those with type 1 diabetes are at high risk," the ADA says newer evidence has emerged, as previously reported by Medscape Medical News, that "convincingly demonstrates that COVID-19 severity is more than tripled in individuals with type 1 diabetes."

The letter also cites another study showing that people with type 1 diabetes "have a 3.3 fold greater risk of severe illness, are 3.9 times more likely to be hospitalized with COVID-19, and have a threefold increase in mortality compared to those without type 1 diabetes."

Those risks, they note, are comparable to the increased risk established for those with type 2 diabetes, as shown in a third study from Scotland, published last month.

Asked for comment, CDC representative Kirsten Nordlund told Medscape Medical News, "This list is a living document that will be periodically updated by CDC, and it could rapidly change as the science evolves."

In addition, Nordlund said, "Decisions about transitioning to subsequent phases should depend on supply, demand, equitable vaccine distribution, and local, state, or territorial context."

"Phased vaccine recommendations are meant to be fluid and not restrictive for jurisdictions. It is not necessary to vaccinate all individuals in one phase before initiating the next phase; phases may overlap," she noted. More information is available here.

Tennessee Gives Type 1 and Type 2 Diabetes Equal Priority for Vaccination

Meanwhile, at least one state, Tennessee, has updated its guidance to include both types of diabetes as being priority for COVID-19 vaccination.

Vanderbilt University pediatric endocrinologist Justin M. Gregory, MD, told Medscape Medical News: "I was thrilled when our state modified its guidance on December 30th to include both type 1 and type 2 diabetes in the 'high risk category.' Other states have not modified that guidance though."

It's unclear how this might play out on the ground, noted Gregory, who led one of the three studies demonstrating increased COVID-19 risk for people with type 1 diabetes.

"To tell you the truth, I don't really know how individual organizations dispensing the vaccination [will handle] people who come to their facility saying they have 'diabetes.' Individual states set the vaccine dispensing guidance and individual county health departments and healthcare systems mirror that guidance," he said.

Thus, he added, "Although it's possible an individual nurse may take the 'I'll ask you no questions and you'll tell me no lies' approach if someone with type 1 diabetes says they have 'diabetes', websites and health department recorded telephone messages are going to tell people with type 1 diabetes they have to wait further back in line if that is what their state's guidance directs."

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