This content originally appeared on Beyond Type 1. Republished with permission.
By Lala Jackson
We now have two FDA-approved and safe COVID-19 vaccines in the US! So as a person with type 1 diabetes, you may be wondering when you can get yours.
The answer? Unclear. It’s all a bit of a logistical mess right now, but here’s what we do know – when you are able to receive your COVID-19 vaccine is dependent on your age, your specific health history (not necessarily whether or not you can check the ‘type 1 diabetes’ box on a form), the state and county in which you live, your employment type, and your healthcare provider’s recommendations.
Overall, having type 1 diabetes does not seem to put anyone more at risk for contracting the novel coronavirus, but other factors like older age, high-exposure employment, consistently elevated blood glucose levels, or other non-diabetes related health factors like obesity and hypertension may increase your risk of infection.
However, we also know that diabetes care itself is made far more complicated after contracting COVID-19 and protecting anyone with diabetes from COVID-19 is our ultimate goal. That’s why Beyond Type 1 has signed onto calls to action urging equal prioritization and is working closely with JDRF, the ADA, and other diabetes patient organizations to advocate for all people with diabetes to be included in Phase 1c of the CDC’s immunization recommendations.
Additionally, because vaccine rollout is happening on a state level, individual advocacy at a state level may be more efficient than federal action. In your community, reach out to your state representatives to let them know that people with any type of diabetes should be included in Phase 1c. Utilize JDRF’s COVID-19 Vaccine Access Toolkit for more resources.
The COVID-19 Vaccine Phased Us Rollout
In the US, the vaccine is being rolled out in phases in *most* states. Already, there are inconsistencies that make it difficult to estimate when you might get a vaccine.
Following approval of the vaccines, the CDC’s Advisory Committee on Immunization Practices created a set of rollout guidelines they recommend for states to follow. These guidelines include phased recommendations for which groups of people should be prioritized to receive the COVID-19 vaccines based on risk factors like older age, underlying health conditions, and lines of work that expose them to COVID-19.
Phase 1a is in process, having begun in December 2020 immediately following the approval of the COVID-19 vaccines in the US. It includes frontline healthcare providers and residents of nursing homes, where COVID-19 cases and deaths have been dramatically highest.
Phase 1b is happening in some states already, includes people over the age of 74, and expands to more frontline workers, including first responders, food and agricultural workers, U.S. Postal Service workers, manufacturing workers, grocery store workers, public transit workers, teachers, and child care workers.
Phase 1c is also happening in some states already, while still several months out others. This phase includes people over the age of 64, anyone else aged 16 or above with medical conditions that increase the risk for severe COVID-19*, and all other essential workers, like those in transportation and logistics, water and wastewater, food service, construction, finance, information technology and communications, energy, legal, media, public safety, and public health workers.
Note that Phase 1c is a BROAD group of people, and this is where things get a bit fuzzy. It is up to each state to control rollout. Many states are following the CDC’s recommendations quite closely, some are following them but not precisely (grouping some phases together, accelerating others), and some have created their own systems, often down to a county-by-county basis.
*What Does This Mean for People With Diabetes?
For people living with diabetes who are not otherwise prioritized because of age or employment type, Phase 1c is the one to look at carefully. As defined by the CDC, people aged 16 or over with medical conditions that increase the risk for severe COVID-19 are included in this phase. But what medical conditions are included?
Short answer – it’s in flux and it depends entirely on your state. Important to remember is that the CDC’s recommendations are just that – recommendations. They have very purposely created guidelines to inform rollout based on most recently available data on high-risk medical conditions, but their guidelines are not meant to be absolute law.
Currently included in Phase 1c recommendations are people with the following conditions: cancer, chronic kidney disease, sickle cell disease, COPD, Down Syndrome, heart conditions, weakened immune systems, obesity, pregnancy, smoking, or Type 2 diabetes.
This means that for those with type 1 or any type of diabetes other than Type 2, you are possibly, depending on your state, not included in the initial rollout and may need to wait to receive your vaccine with the general population, which is likely to be in April 2021 or later.
But don’t panic – as we’ll explain further below, you may still be able to receive the vaccine earlier, based on state or based on your specific health history.
Type 1 Diabetes + COVID-19
Type 1 diabetes itself is not likely to make you more at risk of catching coronavirus. While some have pointed toward the callout of people with immunocompromised systems being in Phase 1c, it is important to remember that having an autoimmune disease (where the immune system attacks itself) is not the same thing as being immunocompromised (where the immune system is susceptible to outside illnesses).
However, other factors associated with T1D may increase your risk of more intense symptoms and severe complications, and if you have to get hospitalized for COVID-19, diabetes care becomes dicey.
This is a piece that has been very confusing and not communicated as clearly as it could be throughout the pandemic – the factors that make a person with any type of diabetes most at risk catching coronavirus and for experiencing severe symptoms and complications of COVID-19 are systemic racism (like being denied or not believed when care is needed), healthcare access issues (like not being able to see a doctor for non-COVID care when needed, or not being able to afford medications and supplies because of job or healthcare loss), consistently elevated blood glucose levels, recent diabetes ketoacidosis, jobs that increase exposure to COVID-19, etc.
Type 1 diabetes combined with these factors does create elevated risk. But well-controlled type 1 diabetes on its own does not seem to make someone more at risk of severe illness from COVID-19.
A few studies have raised concerns that outcomes for people with type 1 diabetes who get COVID-19 are far more severe than a person without diabetes, but digging into those studies provides clarity on what’s actually being shown.
- In May 2020, the UK’s health system released numbers showing severe hospitalization and death rates for people with diabetes. It sounded scary, but what it did not clarify was that additional risk factors like heart disease were of great impact to outcomes, and that the study actually showed that people with type 1 diabetes and no other underlying risk factors like older age or other health history actually did quite well – they were not frequently hospitalized for COVID-19 and those who were had low frequencies of severe outcomes.
- In December 2020, a similar study was released in Diabetes Care, with a headline saying that COVID-19 severity is tripled in the diabetes community. But again, what it did not immediately clarify was how much the severity was dependent on additional factors, like race (due to long-standing systemic racism), elevated HbA1c, hypertension, lack of diabetes technology, lack of health insurance, less diabetes technology use, etc.
Another study that shows these risk factors well was published in July 2020, outlining the fact that older age and other health-related risk factors were more impactful on severe outcomes than diabetes itself, particularly type 1 diabetes.
Overall, yes – anyone living with diabetes of any type needs to pay careful attention to their health amidst this pandemic. The safest thing anyone can do is practice safety measures to avoid getting COVID-19. For those who cannot – essential workers or people who otherwise have to be exposed to the virus – or those with other underlying health factors, those are the most important factors that must be taken into consideration for priority vaccination.
But just having type 1 diabetes alone, if you are otherwise healthy and not significantly exposed to the virus, should not give you reason to panic. Perhaps more important is ensuring everyone in the general public gets vaccinated as quickly as possible so that diabetes care can be safely accessed, and so hospitals and ICUs are not overwhelmed by COVID-19 patients in the event of emergency diabetes care needs.
How You Get Your Vaccine
Look up your state health department’s guidelines. If it is unclear or you are unsatisfied with what you’ve found, go ahead and reach out to your healthcare provider. Particularly if you have a healthcare provider like an endocrinologist who helps you take care of your diabetes, they may have some insider information on how their hospital or practice is planning to distribute the vaccine.
Remember to be kind and patient – healthcare providers are carrying an immense amount and they may not have an answer for you immediately.
Every vaccine taken decreases the risk and prevents the spread of COVID-19. While it is frustrating to watch the logistical mess, the more people who get vaccinated quickly the better, and in the meantime, continue to practice safe measures that protect you and your loved ones from COVID-19, including doing your best to keep tight control of your blood sugar levels, wearing a mask and physical distancing from anyone outside of your household, and avoiding indoor gatherings.
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