A UK nationwide study of people with type 1 diabetes admitted to hospital with COVID-19 infection

Abstract

Aims/hypothesis The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. Methods A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. Results Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55–74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. Conclusions/interpretation In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. In people with Type 1 diabetes and COVID-19 admitted to hospital in the UK, BMI and one or more microvascular complications had a positive association and low serum creatine levels had a negative association with death/admission to intensive care unit after adjusting for age.

Higher rate of COVID-19 mortality in patients with type 1 than type 2 diabetes: a nationwide study

“…Previous studies from different countries reported the hospitalization rates in patients with T1DM between 21.9% and 51%. Also, almost one-third of our patients were admitted to the ICU, which was recorded as 5% to 35% in other studies from different countries [17,22,25,26]. In the CORONADO study, 19.6% of patients with T1DM required mechanical ventilation [23].…”

“…A whole-population study from England reported a 3.5% death rate among T1DM patients [16,20]. The rate of mortality in the CORONADO study was 5.4% [23], while a recent UK study reported a 27% death rate in COVID-19 patients [22]. A multicentre and another small-scale study from the United States reported 9% and 3% death rates, respectively [17,18].…”

COVID-19 Vaccine-Induced Pneumonitis, Myositis and Myopericarditis

“…A number of studies have suggested an association of co-morbidities with the COVID-19 infection [5][6][7][8].…”

COVID-19 and diabetes: a deadly duo?

“…The data on type 1 diabetes specifically are far more limited. A UK nationwide study by Ruan et al [12], which aimed to assess the clinical characteristics and risk factors of adults with both COVID-19 and type 1 diabetes, reported 53 deaths among 194 analysed patients, constituting a mortality rate of 27.32%. This result is very much consistent with the rate of 27.27% determined in this study.…”