Type 1, type 2 diabetes linked to higher odds of COVID-19 mortality in England
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One-third of people in England who died of COVID-19 in a hospital through May 11 had previously been diagnosed with type 1 or type 2 diabetes, according to a study published in The Lancet Diabetes & Endocrinology.
“To our knowledge, this is the largest COVID-19-related whole-population study, covering almost the entire population of England, and is the first study to investigate the relative and absolute risk of death in hospital with COVID-19 by type of diabetes, adjusting for key confounding factors,” Jonathan Valabhji, BSc, MBBS, MD, FRCP, national clinical director for diabetes and obesity at National Health Service (NHS) England and NHS Improvement, and colleagues wrote. “Our results show an increased risk in people with diabetes, with a third of all in-hospital deaths with COVID-19 occurring in people with diabetes.”
Researchers conducted a whole-population study consisting of every person who was alive and registered with a general practice in England on Feb. 16 (n = 61,414,470). Individuals were considered as having diabetes if they were listed as diagnosed with the disease in the last extract of electronic health record information from the National Commissioning Data Repository from 2018 to March 2019. Of all individuals in the study, 4.7% had type 2 diabetes and 0.4% had type 1 diabetes.
Deaths in hospitals from COVID-19 were taken from a dedicated data collection system set up as part of England’s COVID-19 response. Individuals had to have a positive test for COVID-19 from March to April 28 to be included. After April 28, individuals were also included if COVID-19 was registered as a cause of death. Data for the study were collected through May 11.
As of May 11, 23,698 people died of COVID-19 in England hospitals, with 31.4% having type 2 diabetes and 1.5% type 1 diabetes. The rate of in-hospital mortality from COVID-19 for the entire population (39 deaths per 100,000 people; 95% CI, 38-39) was lower than the rate for people with type 2 diabetes (165 deaths per 100,000 people; 95% CI, 129-209) and type 1 diabetes (138 deaths per 100,000 people; 95% CI, 124-153).
After adjusting for age, sex, index of multiple deprivation, ethnicity and region, the odds for death from COVID-19 were significantly higher for people with type 1 diabetes (OR = 3.51; 95% CI, 3.16-3.9) and type 2 diabetes (OR = 2.03; 95% CI, 1.97-2.09) compared with people without diabetes. The odds remained higher for type 1 diabetes (OR = 2.86; 95% CI, 2.58-3.18) and type 2 diabetes (OR = 1.8; 95% CI, 1.75-1.86) after adjusting for cardiovascular comorbidities.
After restricting data to people younger than 70 years, those with type 1 diabetes (OR = 6.39; 95% CI, 5.4-7.56) and type 2 diabetes (OR = 3.74; 95% CI, 3.5-3.99) had higher odds of COVID-19 mortality than those without diabetes in the same age group.
Women with type 2 diabetes (OR = 2.19; 95% CI, 2.09-2.29) and men with type 2 diabetes (OR = 1.94; 95% CI, 1.87-2.01) had higher ORs compared with those without diabetes. Black people with type 2 diabetes (OR = 2.76; 95% CI, 2.46-3.09) had significantly higher odds of COVID-19 mortality compared with Black people without diabetes. Lower ORs were present for white people with type 2 diabetes (OR = 1.97; 95% CI, 1.91-2.03) and Asian people with type 2 diabetes (OR = 1.96; 95% CI, 1.77-2.16) when compared with people with no diabetes in their respective ethnicities.
“The findings of the study have important implications for people with diabetes, health care professionals and policymakers,” the researchers wrote. “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.”
Perspective
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Roeland J.W. Middelbeek, MD, Msc
This important study from Barron and colleagues describes the mortality of people with type 1 diabetes and 2 diabetes compared with people without diabetes in the United Kingdom during the COVID-19 pandemic. The data show that there was an increased number of deaths in people with type 1 and type 2 diabetes. The mortality data in people with type 2 diabetes are in line with prior studies that have shown that type 2 diabetes is a risk factor for death from COVID-19. A major new finding of this study is the increased mortality among people with type 1 diabetes and COVID-19.
In a companion paper, the researchers provide more insight into how risk factors contribute to the increased mortality among people with diabetes. They identified diabetes-related complications, glycemic control and BMI as contributing risk factors (Holman N, et al. Lancet Diabetes Endocrinol. 2020;doi:10.1016/S2213-8587(20)30271-0).
Along with diabetes-related complications, age is one of the most important risk factors for mortality in people with diabetes and COVID-19. The absolute numbers of deaths in younger people with diabetes are low, and these data may provide some reassurance to young people with diabetes. As glycemic control is associated with adverse outcomes, improving glycemic control may provide additional benefit in reducing COVID-19-related mortality among people with diabetes.
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