Nationwide Analysis Details Risk of COVID-19-Related Death in Type 1, Type 2 Diabetics

An analysis of data from more than 61 million patients is shedding light on the associations of type 1 and type 2 diabetes, respectively, with coronavirus disease 2019 (COVID-19)-related mortality.

Led by investigators at the Imperial College of London, results of the nationwide analysis found both type 1 and type 2 diabetes were associated with a significant increase in odds of in-hospital mortality with COVID-19.

“The findings of the study have important implications for people with diabetes, health-care professionals, and policy makers,” wrote study investigators. “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.”

While the impact of diabetes status and hyperglycemia have been a major topic of interest for clinicians and researchers during the ongoing pandemic, relatively few studies have examined the risks for type 1 and type 2 diabetes, respectively. With this in mind, investigators designed their study to assess the effects of diabetes status and type on in-hospital death in patients with COVID-19 from March 1-May 11, 2020.

Using NHS data from those registered with a general practice in England and alive on February 16, 2020, investigators identified 61,414,470 individuals for inclusion in their analysis. Of these patients, 0.4% (n=263,830) had a diagnosis of type 11 diabetes, 4.7% (n=2,864,670) had a diagnosis of type 2 diabetes, and 0.1% (n=41,750) had other types of diabetes.

During the study period, 23,698 in-hospital COVID-19-related deaths were recorded. Of these deaths, 31.4% (n=7434) had type 2 diabetes, 1.5% (n=364) had type 1 diabetes, and 0.3% (n=69) had other forms of diabetes. Investigators pointed out the unadjusted mortality rates per 100,000 people over the 72-day study period was 27 (95% CI 27–28) for those without diabetes, 138 (124–153) for those with type 1 diabetes, and 260 (254–265) for those with type 2 diabetes.

In analyses adjusting for age, sex, deprivation, ethnicity, and region, patients with type 1 diabetes were at more than a 3-fold increase of in-hospital COVID-19-related death compared tot hose without diabetes (OR, 3.51; 95% CI, 3.16-3.90). In these same analyses, type 2 diabetics were 2 times more likely to experience in-hospital COVID-19-related death (OR, 2.03; 95% CI, 1.97-2.09). Upon adjustment for previous hospital admissions with coronary heart disease, cerebrovascular disease, or heart failure, the odds for in-hospital COVID-19-related death for type 1 diabetics were 2.86-times greater and the odds for patients with type 2 diabetes were 1.80-times greater when comparing these groups to nondiabetic patients.

“For older people who are at higher absolute risk, the results can inform public guidance, including recommendations for shielding,” wrote investigators. “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.”

This study, “Associations of type 1 and type 2 diabetes with COVID-19- related mortality in England: a whole-population study,” was published in The Lancet: Diabetes & Endocrinology.