In “better late than never” news, the United States Center for Disease Control and Prevention (CDC) has promoted Type 1 diabetes to a “high risk” category. The shift may help give some Americans with the condition priority for the Covid-19 vaccine; for many others though, the change comes too late to make a material difference.
Tip of the hat to Medscape’s Miriam Tucker, who reported the news.
While it’s nice to see the CDC finally give Type 1 diabetes its due as a very dangerous underlying condition during the pandemic, there are several reasons to doubt the efficacy of this late change. Some states have elected to more or less do away with risk categories and prioritize age above most other factors; other states have pointedly ignored the CDC guidance and developed their own risk hierarchy. And most importantly, vaccine distribution has been a huge success thus far that in many communities adults with T1D can get their vaccine now without any priority necessary. The United States as a whole is administering nearly 3 million doses per day, enough to vaccinate every adult in the country by Independence Day.
Type 1 diabetes (T1D) wasn’t the only condition elevated to a higher risk level. The list includes moderate and severe asthma, liver disease, cystic fibrosis and overweight. Given that this last category includes about 60,000,000 American adults—almost 75% of the country’s adults are overweight or obese—patients with T1D can be forgiven for being skeptical about how much their new priority will count for.
Diabetes advocates were initially shocked when the CDC, releasing its first guidance on the issue, had labeled Type 1 diabetes in the category of conditions that only “might” increase risk of death or severe illness from Covid-19.
Diabetes organizations have been lobbying strenuously for a change ever since. In January, the prestigious medical journal The Lancet published a letter by diabetes experts demanding “immediate revision by the CDC” to its classification of Type 1 diabetes as a condition that only “might be” of higher risk. The same week, the ADA, JDRF, and many of the country’s other most influential diabetes organizations joined in a formal letter to the CDC requesting the same change. We’ve been banging the same drum for months. In December we put forth the case as best we could: Why People with Type 1 Diabetes Should Get Priority for COVID-19 Vaccines.
Here’s the case again in a nutshell: what evidence we have clearly indicates that people with Type 1 diabetes are at least as likely to suffer severe illness and death from Covid-19 as are people with Type 2 diabetes, if not more so. The best studies we have on the subject, performed on patient data from Scotland, England and Tennessee, all agree. It simply doesn’t make much sense to have the two types of diabetes in different risk categories. And given that Type 2 diabetes has been identified since the very first days of the pandemic as one of the most hazardous comorbidities, it seems obvious that Type 1 diabetes should receive high vaccination priority.
We are now in what the CDC calls Phase 1c of the vaccine rollout, in which priority is recommended for essential workers (broadly considered), anyone over the age of 65, and people aged 16-64 with higher risk underlying conditions. In reality, many states have already blown clear past Phase 1c and have begun vaccinating younger adults without underlying conditions.