Experts demand “immediate revision” to vaccine policy for Type 1 diabetes
If you’re an American with Type 1 diabetes and you’ve tried to sign up for a COVID-19 vaccine, you may have been surprised to learn that you are not considered a “high risk” individual and that you are not eligible for vaccine priority. The Centers for Disease Control and Prevention (CDC) still considers Type 2 diabetes a higher risk than Type 1. The problem is that this determination conflicts with the science, and experts are calling for immediate change.
The Lancet, one of the world’s most prestigious medical journals, has published a letter this week demanding “an immediate revision by the CDC” and other authorities, in order to place individuals with Type 1 diabetes in the same high-risk category as those with Type 2. Among the letter’s contributors were two Vanderbilt University doctors, colleagues of the researchers that have produced some of the most convincing evidence demonstrating the high risks of COVID-19 to people with T1D.
The Lancet is just one of several major sources to call for this change in recent days. On January 13, the American Diabetes Association sent a formal letter to the CDC similarly arguing for “immediate steps to update CDC’s guidance.” The letter, authored by Dr. Robert Gabbay, the ADA’s Chief Scientific and Medical Officer, was co-signed by leaders from most the country’s significant diabetes organizations, including JDRF, the Diabetes Leadership Council, and the American Association of Clinical Endocrinology.
“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 new science in question refers to three different studies, performed in Scotland, England and Tennessee, all of which found that the risks of severe illness and death from COVID-19 were both highly elevated in patients with Type 1 diabetes and substantially similar to the risks suffered by patients with Type 2 diabetes. There seems to be no serious contrary evidence.
Nevertheless, at the moment the CDC distinguishes between the two conditions, advising that adults with Type 2 diabetes “are at an increased risk,” whereas those with Type 1 “might be at an increased risk” (emphasis added). Other conditions that officially “might” pose an increased risk include several exceedingly common conditions, including hypertension and overweight (BMI > 25), which affect tens of millions of American adults. There are about 1.6 million Americans with Type 1 diabetes.
We first put forth our own argument for T1D vaccine priority in December: Why People with Type 1 Diabetes Should Get Priority for COVID-19 Vaccines. Since then several other media organizations have joined the chorus, including PBS News Hour. Medscape’s Miriam Tucker recently reported on the mounting pressure that the CDC is facing on the issue. The CDC’s recommendations are not binding, and states and other local authorities ultimately have discretion on how they administer the vaccines they have in their possession. Several states—including California, Ohio, Tennessee and Virginia—have already jumped out in front of the CDC and designated Type 1 diabetes a “high risk” condition. JDRF has uploaded a very thorough guide to advocacy on this topic, including advice for how you can contribute yourself.
In the meantime, as we await vaccine distribution, distancing and hygiene remain paramount for people with diabetes. The Vanderbilt University study concluded with a “call on our colleagues to emphasize the importance of social distancing measures and hand hygiene, with particular emphasis on patients with diabetes, including those in the most vulnerable communities whom our study affirms will face the most severe impact.”