A recent large-scale study concludes that both type 1 and type 2 diabetes are associated with an increased risk of COVID-19-related in-hospital death. It finds that one-third of coronavirus-related deaths in hospitals in England are individuals with diabetes.
Over the last few months, researchers have rushed to gather information on the effects of a virus that, just last year, was unknown to science. The virus, SARS-CoV-2, causes the disease COVID-19.
Now, with millions of cases globally, scientists are trying to understand which factors have an association with poorer outcomes.
Among these factors is diabetes. As the authors of the recent study explain, early analyses from Italy, China, the United States, and the United Kingdom suggest that individuals with diabetes have an increased risk of developing more severe cases of COVID-19.
However, until now, studies have not differentiated between type 1 and type 2 diabetes; the latest investigation addresses this gap in our understanding.
The findings are available from the U.K.’s National Health Service (NHS) website; they have not yet been peer reviewed and are awaiting publication.
According to the authors, their study is “the largest COVID-19 related study, covering almost the entire population of England, and is the first study to investigate the relative and absolute risks of death in hospital with COVID-19 by type of diabetes, adjusting for key confounders.”
To investigate, the researchers used data from the National Diabetes Audit: an estimated 98% of doctor’s offices in England participated in this program, the purpose of which is to help monitor and improve diabetes services.
The scientists extracted information from the COVID Patient Notification System, which registers all hospital deaths related to COVID-19. They used data from March 1–May 11, 2020.
As part of the analysis, the authors adjusted their findings for factors that might influence the results, such as age, sex, deprivation, ethnicity, and existing health conditions.
Of the 61,414,470 people registered at a doctor’s office in the U.K., 263,830 individuals had a type 1 diabetes diagnosis, and 2,864,670 had a type 2 diabetes diagnosis. The authors write:
“There were 23,804 COVID-19 related deaths. One-third occurred in people with diabetes: 7,466 (31.4%) with type 2 and 365 (1.5%) with type 1 diabetes.”
After adjusting for age, sex, deprivation, ethnicity, and geographical region, the researchers found that, compared with individuals without diabetes, people with type 1 diabetes had 3.5 times the odds of dying in the hospital with COVID-19. Similarly, individuals with type 2 diabetes had 2.03 times the odds of dying in the hospital with COVID-19.
When the researchers adjusted the data to account for previous hospital admission with coronary heart disease, cerebrovascular disease, or heart failure, the odds changed to 2.86 and 1.81, respectively.
Overall, the authors conclude that “all types of diabetes are independently associated with a significant increased risk of in-hospital death with COVID-19.”
The authors also looked at other characteristics they associated with in-hospital COVID-19 deaths. They found that the average age of death was 78.6 and that 61.5% were males. They also identified an association between previous coronary heart disease and an increased risk of death.
When they split the data into five levels of depravation, they demonstrated that “The highest proportion of deaths were in those from the most deprived [fifth] of the population (23.8%), decreasing to 15.8% from the least deprived [fifth].”
Their analysis also found an increased risk for people of black, Asian, or mixed ethnicity.
In agreement with earlier research, the authors found that advanced age strongly influences the risk of in-hospital death from COVID-19; they write:
“[T]here is a 700-fold difference in risk between those aged under 40 compared to those over 80.”
The authors continue, “Age was the dominant risk factor for in-hospital death with COVID-19 and had a much greater influence on risk than diabetes status, sex, ethnicity, or socioeconomic deprivation.”
“Even with the additional risk associated with type 1 diabetes or type 2 diabetes,” they emphasize, “people under the age of 40 years with either type of diabetes were at very low absolute risk of in-hospital death with COVID-19 during the observation period of this study in England.”
The authors note that the study was limited because they could not account for all previous or existing medical conditions. In particular, they mention hypertension and chronic kidney disease, which they could not include due to a lack of available data.
In their conclusion, the authors “encourage the use of these findings, along with those from other studies investigating associations with serious COVID-19 related outcomes, to provide reassurance for people who are at low absolute risk, despite having diabetes.”
“For those who are at higher risk,” they explain, “the results inform public guidance, including recommendations for shielding.”
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