A recent large-scale study concludes that both type 1 and type 2 diabetes are associated with increased risk of in-hospital death due to COVID-19. This estimates that one third of coronavirus-related deaths in England’s hospitals are people with diabetes.
Researchers have rushed over the past few months to collect information on the impact of a virus that was unknown to science just last year. SARS-CoV-2, the virus causes the COVID-19 disease.
Now, with millions of globally occurring cases, scientists are trying to understand which factors are associated with poorer outcomes.
Diabetes is one such factor. Early analyzes from Italy, China, the United States and the United Kingdom, as the authors of the recent study demonstrate, indicate that individuals with diabetes have an increased chance of experiencing more serious COVID-19 cases.
However, studies have not distinguished between type 1 and type 2 diabetes until now; this difference in our understanding is discussed in the current investigation.
The reports are available from the website of the United Kingdom’s National Health Service ( NHS); they have not yet been peer reviewed and are pending publication.
Diabetes and COVID-19
According to the authors, their report is “the largest COVID-19 related study, covering almost the entire population of England, and it is the first study to examine the relative and absolute risk of death in hospital with COVID-19 by form of diabetes, adapting to key confounders.”
The researchers used data from the National Diabetes Audit to investigate: an estimated 98 percent of doctor’s offices in England were participating in this initiative, which seeks to better track and enhance diabetes services.
The scientists have extracted information from the COVID Patient Notification System which records all COVID-19 related hospital deaths. They used the March 1–May 11, 2020 info.
As part of the study, the authors modified their results for factors that could affect results, such as age , sex, poverty, ethnicity, and current health.
Of the 61,414,470 people registered at a UK doctor’s office, 263,830 people were diagnosed with type 1 diabetes, and 2,864,670 were diagnosed with type 2 diabetes. 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 people with type 1 diabetes had 3.5 times the chances of dying with COVID-19 in the hospital compared to individuals without diabetes. Similarly, people with type 2 diabetes had 2.03 times the chances of dying with COVID-19 in hospital.
The odds changed to 2.86 and 1.81, respectively, when the researchers adjusted the data to account for previous hospital admission with coronary heart disease, cerebrovascular disease or heart failure.
Overall, the authors conclude that “all types of diabetes are independently associated with a significant increased risk of in-hospital death with COVID-19.”
Other findings
The authors also looked into other features associated with COVID-19 deaths in hospital. They found the average death age to be 78.6, and that 61.5 percent were males. They also found a correlation between past coronary heart disease and increased risk of death.
When they divided the data into five levels of depravity, they found that “the highest proportion of deaths were among those from the most poor [fifth] of the population (23.8 per cent), dropping from the least deprived [fifth] to 15.8 per cent.”
Their analysis also found an increased risk for black , Asian or mixed ethnicity population groups.
The authors, in agreement with earlier research, found that advanced age greatly influences the risk of COVID-19 in-hospital death; they write:
“[T]here is a 700-fold difference in risk between those aged under 40 compared to those over 80.”
The authors add, “Age was the dominant risk factor for COVID-19 in-hospital death and had a much greater risk impact 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 analysis was limited because they were unable to account for all previous or current conditions. They list, in particular, hypertension and chronic kidney disease, which they did not include due to a lack of data.
The writers, in their conclusion, “encourage the use of these results, along with those from other studies examining associations with serious COVID-19 related outcomes, to provide reassurance for people at low absolute risk of diabetes.”
“The reports give the public guidance, including recommendations for shielding,” they say, “for those at higher risk.”
