Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study

Abstract

Background Diabetes has been associated with increased COVID-19-related mortality, but the association between modifiable risk factors, including hyperglycaemia and obesity, and COVID-19-related mortality among people with diabetes is unclear. We assessed associations between risk factors and COVID-19-related mortality in people with type 1 and type 2 diabetes. Methods We did a population-based cohort study of people with diagnosed diabetes who were registered with a general practice in England. National population data on people with type 1 and type 2 diabetes collated by the National Diabetes Audit were linked to mortality records collated by the Office for National Statistics from Jan 2, 2017, to May 11, 2020. We identified the weekly number of deaths in people with type 1 and type 2 diabetes during the first 19 weeks of 2020 and calculated the percentage change from the mean number of deaths for the corresponding weeks in 2017, 2018, and 2019. The associations between risk factors (including sex, age, ethnicity, socioeconomic deprivation, HbA 1c , renal impairment [from estimated glomerular filtration rate (eGFR)], BMI, tobacco smoking status, and cardiovascular comorbidities) and COVID-19-related mortality (defined as International Classification of Diseases, version 10, code U07.1 or U07.2 as a primary or secondary cause of death) between Feb 16 and May 11, 2020, were investigated by use of Cox proportional hazards models. Findings Weekly death registrations in the first 19 weeks of 2020 exceeded the corresponding 3-year weekly averages for 2017–19 by 672 (50·9%) in people with type 1 diabetes and 16 071 (64·3%) in people with type 2 diabetes. Between Feb 16 and May 11, 2020, among 264 390 people with type 1 diabetes and 2 874 020 people with type 2 diabetes, 1604 people with type 1 diabetes and 36 291 people with type 2 diabetes died from all causes. Of these total deaths, 464 in people with type 1 diabetes and 10 525 in people with type 2 diabetes were defined as COVID-19 related, of which 289 (62·3%) and 5833 (55·4%), respectively, occurred in people with a history of cardiovascular disease or with renal impairment (eGFR <60 mL/min per 1·73 m 2 ). Male sex, older age, renal impairment, non-white ethnicity, socioeconomic deprivation, and previous stroke and heart failure were associated with increased COVID-19-related mortality in both type 1 and type 2 diabetes. Compared with people with an HbA 1c of 48–53 mmol/mol (6·5–7·0%), people with an HbA 1c of 86 mmol/mol (10·0%) or higher had increased COVID-19-related mortality (hazard ratio [HR] 2·23 [95% CI 1·50–3·30, p<0·0001] in type 1 diabetes and 1·61 [1·47–1·77, p<0·0001] in type 2 diabetes). In addition, in people with type 2 diabetes, COVID-19-related mortality was significantly higher in those with an HbA 1c of 59 mmol/mol (7·6%) or higher tha...

Antibody response to multiple antigens of SARS-CoV-2 in patients with diabetes: an observational cohort study

“…In addition to the humoral response data, our cohort also provided additional insights into the relationship between diabetes, hyperglycaemia and COVID-19 pneumonia. First, we confirmed that hyperglycaemia was independently associated with a poorer in-hospital outcome, even after the results were adjusted for age, sex, obesity and other relevant comorbidities, as recently reported [37]. Second, patients with a diagnosis of diabetes, either comorbid or newly diagnosed, with better controlled blood glucose levels had less severe COVID-19 pneumonia and lower mortality risk compared with those with poorly controlled blood glucose during hospitalisation [38].…”

Criterios de retorno al trabajo y determinación del valor de vulnerabilidad por Covid-19

“…El RR en personas con DM2 y HbA1c menor a 6.5% es más bajo, con sólo un RR de 1.1 (IC95% 1.04-1.18) (B2b). 23 El control de la DM es esencial en los pacientes con Covid-19 (5D). 24 Hay evidencia estadísticamente significativa de que los valores de hemoglobina glucosilada del grupo de 8.1% (IC95%, 7.2-10.1) predicen pronóstico desfavorable, por lo que se tomó el valor de 8% para el criterio de vulnerabilidad.…”

“…36 No se encontraron estudios previos que relacionaran sólo la tasa de filtración glomerular (TFG) previa a salud pública de méxico Hernández-Ávila M y col. la infección con el pronóstico; no obstante, en un estudio que buscó mortalidad en pacientes con DM tipo 2 se hizo un análisis de la TFG previa y se encontró que aquéllos con 30-44 ml/min/1.72m 2 tenían el doble de riesgo que aquéllos con >60 (RR 2.16, IC95% 1.59-2.93), y el riesgo aumentaba aún más cuando la TFG estaba por debajo de 15 (RR 6.8, IC95% 4.65-10.09) (B2b). 23 En una cohorte retrospectiva nacional en China se identificó que la ERC se asoció con mayor riesgo de neumonía por cualquier agente (RR 1.97, IC95% 1.89-2.05; p<0,001) (B2b). 37 Las tasas de neumonía en pacientes con ERC con TFG <30 son casi tres veces mayores (D5).…”

Privacy-Protecting, Reliable Response Data Discovery Using COVID-19 Patient Observations

“…Several initiatives are building COVID- 19 registries or consortia to analyze electronic health record (EHR) data (6,7,9). The expectation is that these resources will provide researchers and clinicians access to a rich source of observational data to understand the clinical progression of COVID-19, to estimate the impact of therapies, and to make predictions regarding outcomes.…”

“…2) indicate that age is a major risk factor, but ethnicity and gender are also significant when considered univariately. There is great interest and growing peer-reviewed literature on risk factors for COVID-19 mortality: the agility of our approach allows us to quickly re-run queries and rebuild models as new predictors become relevant and the understanding of the disease evolves (17)(18)(19)(20).…”