No association between type 1 diabetes status, COVID-19 hospitalization risk
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Type 1 diabetes does not increase risk for hospitalization from COVID-19, particularly among individuals without diabetes complications, according to an analysis of hospital data.
While data show a higher incidence of severe acute respiratory distress syndrome and increased mortality among patients with diabetes, most patients have type 2 diabetes; less is known about the implications of type 1 diabetes in COVID-19, Roeland J.W. Middelbeek, MD, Msc, staff physician, research associate and instructor in medicine at Harvard Medical School and Joslin Diabetes Center, and colleagues wrote in an article published in Diabetes Care.
“In our study of adults with type 1 diabetes admitted to an academic center and who are found to have been infected with COVID-19, we find that their clinical characteristics are quite similar as adults with type 1 diabetes who were admitted to the hospital for other reasons,” Middelbeek told Healio. “Adults with type 1 diabetes admitted during the pandemic with and without COVID-19 had a number of preexisting complications from type 1 diabetes.”
In a retrospective study, Middelbeek and colleagues analyzed chart data from 35 adults with an established diagnosis of type 1 diabetes admitted to Beth Israel Deaconess Medical Center in Boston between March 1 and June 1 (mean age, 52 years). Within the cohort, seven patients were COVID-19-positive (five men; four Black), 19 patients tested COVID-19-negative and four were not tested (12 men; two Black). Researchers assessed glycemic data up to 6 months before admission, as well comorbidities and in-hospital disease course. Primary outcome was a composite of ICU admission, intubation or death.
In comparing patients with vs. without COVID-19, researchers observed no between-group differences in sex, body weight, glucose level or HbA1c at admission. Outpatient insulin doses, corrected for body weight and glycemic response before admission, also did not differ between groups.
A majority of patients in both groups had been diagnosed with nephropathy, and 14% in each group were organ transplant recipients on immunosuppression therapy. Diabetic ketoacidosis occurred in one patient in the COVID-19-positive group and two patients in the COVID-19-negative group.
The composite outcome occurred in two COVID-19-positive patients (ICU admission without intubation, both recovered) and in four COVID-19-negative patients, including two deaths.
“Based on the findings that COVID-19-positive patients with type 1 diabetes were not different in their clinical characteristics and outpatient glycemic control vs. COVID-19-negative patients, these findings suggest that having type 1 diabetes, in particular for patients without complications, may not necessarily increase the risk of being hospitalized with COVID-19,” Middelbeek said. “In our small cohort, the clinical course during hospitalization also did not significantly differ between patients with type 1 diabetes who were confirmed to have COVID-19 vs. those who did not.”
Middelbeek said studies that include children and adults with type 1 diabetes can determine to what extent there is an increased risk for infection and complications from COVID-19, and whether the immune response is similar or different from people without type 1 diabetes.
For more information:
Roeland J.W. Middelbeek, MD, Msc, can be reached at Joslin Diabetes Center, One Joslin Place, Boston, MA 02215; email: roeland.middelbeek@joslin.harvard.edu.
Perspective
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This brief report in Diabetes Care describes the characteristics and favorable outcomes of seven people with type 1 diabetes hospitalized with a diagnosis of COVID-19 in Boston, compared with 28 hospitalized adults with type 1 diabetes without a diagnosis of COVID-19. A recent analysis of a much larger patient population from the United Kingdom described increased mortality in hospitalized among individuals with both type 1 and type 2 diabetes (Barron E, et al. Lancet Diabetes Endocrinol. 2020; doi:10.1016/s2213-8587(20)30272-2).
The emerging data worldwide suggest that the degree of hyperglycemia may be associated with adverse outcomes in both type 1 and type 2 diabetes for people with COVID-19 infection, providing a compelling reminder of the importance of optimizing diabetes management in the COVID-19 era.
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