Newly Published Articles Inform on COVID-19 Risk by Diabetes Type

Miriam E. Tucker

August 17, 2020

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Two UK analyses of risk factors linked to COVID-19 mortality in people with type 1 and type 2 diabetes that were issued as preprints have now been peer reviewed and were published in The Lancet Diabetes and Endocrinology.

Both studies came from NHS England. Jonathan Valabhji, national clinical director for diabetes and obesity at NHS England, was lead author for both. Overall, the articles analyze data from more than 61 million people.

One article, with first author Emma Barron, MSc, of Public Health England, York, United Kingdom, is a nationwide whole-population analysis that shows that both type 1 and type 2 diabetes are associated with a significantly increased risk for in-hospital death with COVID-19.

"The results of this nationwide analysis in England show that type 1 and type 2 diabetes were both independently associated with a significant increased odds of in-hospital death with COVID-19," write Barron and colleagues. The results "have important implications for people with diabetes, health-care professionals, and policy makers.

"We encourage the use of these findings, along with those from other studies investigating risk factors for COVID-19-related outcomes, to provide reassurance for young people who are at low absolute risk, despite having diabetes.

"For older people who are at higher absolute risk, the results can inform public guidance, including recommendations for shielding," they observe.

"Further elucidation of the modifiable risk factors for poorer COVID-19 outcomes in people with diabetes will be crucial in guiding management and providing targeted support," they add.

The other study, led by Naomi Holman, PhD, head of health intelligence for the Diabetes Within the National Cardiovascular Intelligence Network, Public Health England, found that increased COVID-19-related mortality was associated with cardiovascular and renal complications, as well as glycemic control and body mass index (BMI).

First Studies to Report on COVID-19 Risks by Diabetes Type

The two studies, conducted from March to May 2020, were the first to examine the relationship between COVID-19 and diabetes separately by diabetes type. They were originally published as preprints on May 20, as reported at the time.

In the whole-population study, more than a third of all 23,698 in-hospital COVID-19 deaths during the study period occurred in people with diabetes, including 31.4% in people with type 2 diabetes and 1.5% in those with type 1 diabetes.

Unadjusted mortality per 100,000 population was 138 for type 1 diabetes and 260 for type 2 diabetes, both significantly higher than the 27 per 100,000 population for those without diabetes.

After adjustment for age, sex, deprivation, ethnicity, and geographic region, compared to people without diabetes, the odds of in-hospital death were 3.5 times higher for those with type 1 diabetes and 2.0 for those with type 2.

However, the risk for death was extremely low for people younger than 40 years with either diabetes type.

The risk factor study involved 464 people with type 1 diabetes and 10,525 with type 2 diabetes who died of COVID-19. Together, these account for much of the excess deaths recorded during the same period in the prior 3 years.

Risk factors for COVID-19-related mortality included many of those seen in the general population, ie, older age, male sex, socioeconomic deprivation, minority race, established cardiovascular disease, and impaired renal function.

However, for those with diabetes, the risk increased with greater A1c level; a U-shaped relationship was seen with BMI.

Holman is funded by Diabetes UK.

Lancet Diabetes Endocrinol. Published online August 13, 2020. Whole population study, Full text; Risk factor study, Full text

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