Background In patients with type 2 diabetes, hyperglycaemia is an independent risk factor for COVID-19-related mortality. Associations between pre-infection prescription for glucose-lowering drugs and COVID-19-related mortality in people with type 2 diabetes have been postulated but only investigated in small studies and limited to a few agents. We investigated whether there are associations between prescription of different classes of glucose-lowering drugs and risk of COVID-19-related mortality in people with type 2 diabetes. MethodsThis was a nationwide observational cohort study done with data from the National Diabetes Audit for people with type 2 diabetes and registered with a general practice in England since 2003. Cox regression was used to estimate the hazard ratio (HR) of COVID-19-related mortality in people prescribed each class of glucose-lowering drug, with covariate adjustment with a propensity score to address confounding by demographic, socioeconomic, and clinical factors. Findings Among the 2 851 465 people with type 2 diabetes included in our analyses, 13 479 (0•5%) COVID-19-related deaths occurred during the study period (Feb 16 to Aug 31, 2020), corresponding to a rate of 8•9 per 1000 person-years (95% CI 8•7-9•0). The adjusted HR associated with recorded versus no recorded prescription was 0•77 (95% CI 0•73-0•81) for metformin and 1•42 (1•35-1•49) for insulin. Adjusted HRs for prescription of other individual classes of glucose-lowering treatment were as follows: 0•75 (0•48-1•17) for meglitinides, 0•82 (0•74-0•91) for SGLT2 inhibitors, 0•94 (0•82-1•07) for thiazolidinediones, 0•94 (0•89-0•99) for sulfonylureas, 0•94 (0•83-1•07) for GLP-1 receptor agonists, 1•07 (1•01-1•13) for DPP-4 inhibitors, and 1•26 (0•76-2•09) for α-glucosidase inhibitors.Interpretation Our results provide evidence of associations between prescription of some glucose-lowering drugs and COVID-19-related mortality, although the differences in risk are small and these findings are likely to be due to confounding by indication, in view of the use of different drug classes at different stages of type 2 diabetes disease progression. In the context of the COVID-19 pandemic, there is no clear indication to change prescribing of glucoselowering drugs in people with type 2 diabetes. Funding None.

<p>  </p> <p><strong>Objective</strong></p> <p>Adolescence is associated with high risk hyperglycaemia. This study examines the phenomenon in a life-course context. </p> <p><strong>Research design and methods</strong></p> <p>93,125 people with type 1 diabetes aged 5-30 years were identified from the National Diabetes Audit (NDA) and/or the National Paediatric Diabetes Audit (NPDA) for England and Wales for 2017/18-2019/20. For each audit year the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analysed in sequential cohorts by year of age. </p> <p><strong>Results </strong></p> <p>In childhood, unreported HbA1c measurement was uncommon but by 19 years had increased to 22.3% for males and 17.3% for females, reducing to 17.9% and 13.1% respectively by 30 years. Median HbA1c at 9 years was 7.6% (60mmol/mol) (IQR 7.1%-8.4%, 54-68mmol/mol) in males and 7.7% (61mmol/mol)  (8.0%-8.4%, 64-68mmol/mol) in females increasing to 8.7% (72mmol/mol) (7.5%-10.3%, 59-89mmol/mol) and 8.9% (74mmol/mol) (7.7%-10.6%, 61-92mmol/mol) respectively at 19 years before falling to 8.4% (68mmol/mol) (7.4%-9.7%, 57-83mmol/mol) and 8.2% (66mmol/mol) (7.3%-9.7%, 56-82mmol/mol) respectively at 30 years. Annual hospitalisation for DKA rose steadily from 6 years (2.0% for males, 1.4% for females) to peak at 19 years for males (7.9%) and 18 years for females (12.7%) reducing to 4.3% for males and 5.4% for females at 30 years. At all ages over 9 years the prevalence of DKA was higher in females. </p> <p><strong>Conclusions</strong></p> <p>HbA1c and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA1c, a marker of clinical review, falls abruptly in the late teenage years.  Age-appropriate services are needed to overcome these issues.</p>

<p>  </p> <p><strong>Objective</strong></p> <p>Adolescence is associated with high risk hyperglycaemia. This study examines the phenomenon in a life-course context. </p> <p><strong>Research design and methods</strong></p> <p>93,125 people with type 1 diabetes aged 5-30 years were identified from the National Diabetes Audit (NDA) and/or the National Paediatric Diabetes Audit (NPDA) for England and Wales for 2017/18-2019/20. For each audit year the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analysed in sequential cohorts by year of age. </p> <p><strong>Results </strong></p> <p>In childhood, unreported HbA1c measurement was uncommon but by 19 years had increased to 22.3% for males and 17.3% for females, reducing to 17.9% and 13.1% respectively by 30 years. Median HbA1c at 9 years was 7.6% (60mmol/mol) (IQR 7.1%-8.4%, 54-68mmol/mol) in males and 7.7% (61mmol/mol)  (8.0%-8.4%, 64-68mmol/mol) in females increasing to 8.7% (72mmol/mol) (7.5%-10.3%, 59-89mmol/mol) and 8.9% (74mmol/mol) (7.7%-10.6%, 61-92mmol/mol) respectively at 19 years before falling to 8.4% (68mmol/mol) (7.4%-9.7%, 57-83mmol/mol) and 8.2% (66mmol/mol) (7.3%-9.7%, 56-82mmol/mol) respectively at 30 years. Annual hospitalisation for DKA rose steadily from 6 years (2.0% for males, 1.4% for females) to peak at 19 years for males (7.9%) and 18 years for females (12.7%) reducing to 4.3% for males and 5.4% for females at 30 years. At all ages over 9 years the prevalence of DKA was higher in females. </p> <p><strong>Conclusions</strong></p> <p>HbA1c and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA1c, a marker of clinical review, falls abruptly in the late teenage years.  Age-appropriate services are needed to overcome these issues.</p>

OBJECTIVE Adolescence is associated with high-risk hyperglycemia. This study examines the phenomenon in a life course context. RESEARCH DESIGN AND METHODS A total of 93,125 people with type 1 diabetes aged 5 to 30 years were identified from the National Diabetes Audit and/or the National Paediatric Diabetes Audit for England and Wales for 2017/2018–2019/2020. For each audit year, the latest HbA1c and hospital admissions for diabetic ketoacidosis (DKA) were identified. Data were analyzed in sequential cohorts by year of age. RESULTS In childhood, unreported HbA1c measurement is uncommon; however, for 19-year-olds, it increases to 22.3% for men and 17.3% for women, and then reduces to 17.9% and 13.1%, respectively, for 30-year-olds. Median HbA1c for 9-year-olds is 7.6% (60 mmol/mol) (interquartile range 7.1–8.4%, 54–68 mmol/mol) in boys and 7.7% (61 mmol/mol) (8.0–8.4%, 64–68 mmol/mol) in girls, increasing to 8.7% (72 mmol/mol) (7.5–10.3%, 59–89 mmol/mol) and 8.9% (74 mmol/mol) (7.7–10.6%, 61–92 mmol/mol), respectively, for 19-year-olds before falling to 8.4% (68 mmol/mol) (7.4–9.7%, 57–83 mmol/mol) and 8.2% (66 mmol/mol) (7.3–9.7%, 56–82 mmol/mol), respectively, for 30-year-olds. Annual hospitalization for DKA rose steadily in age from 6 years (2.0% for boys, 1.4% for girls) and peaked at 19 years for men (7.9%) and 18 years for women (12.7%), reducing to 4.3% for men and 5.4% for women at age 30 years. For all ages over 9 years, the prevalence of DKA was higher in female individuals. CONCLUSIONS HbA1c and the prevalence of DKA increase through adolescence and then decline. Measurement of HbA1c, a marker of clinical review, falls abruptly in the late teenage years. Age-appropriate services are needed to overcome these issues.