COVID-19 mortality risk is finally assessed by type of diabetes

  • NHS England

  • curated by Miriam Tucker
  • Clinical Essentials
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  • Note: As an exception during this period of health crisis, some of the publications mentioned are at the time of writing still in prepublication, undergoing peer review, and subject to change. The results of this preprint study should be interpreted with utmost caution.

Takeaway

  • In both type 1 (T1D) and type 2 diabetes (T2D), the modifiable risk factors hyperglycemia and obesity are independently associated with increased COVID-19 mortality.

Why this matters

  • Previous studies showing increased COVID-19 mortality in patients with diabetes have not stratified by type.

Study design

  • National data in England analyzed for 265,090 people with T1D and 2,889,210 people with T2D from January 1, 2017 to May 1, 2020. 
  • Data included 418 COVID-19-related deaths among those with T1D and 9377 among those with T2D, January 1-May 1, 2020.
  • Funding: NHS England & Improvement; NHS Digital.

Key results

  • Total deaths/week more than doubled since April 3, 2020 vs prior years.
  • For T2D, compared with HbA1c 48-53 mmol/mol, adjusted (a)HRs (95% CIs) for HbA1c:
    • 59-74 mmol/mol: 1.23 (1.15-1.32).
    • ≥86 mmol/mol: 1.62 (1.48-1.79).
  • For T1D, comparison was significant only for HbA1c ≥86 mmol/mol:
    • aHR, 2.19 (95% CI, 1.46-3.29).
  • For T1D, compared with BMI 25-29.9 kg/m2, aHR (95% CIs) for BMI:
    • 20 kg/m2: 2.11 (1.32-3.38).
    • ≥40 kg/m2: 2.15 (1.37-3.36).
  • For T2D, vs BMI 25-29.9 kg/m2, aHR (95% CIs) for BMI:
    • 20 kg/m2: 2.26 (2.04-2.50). 
    • ≥40 kg/m2: 1.46 (1.50-1.79).
  • Vs age 60-69 years, risks (aHRs) varied with age:
    • T1D: 0.03 for age
    • For T2D, this range was 0.22-4.39.   

Limitations

  • No data on specific causes of death.