Severe COVID-19 Infection in Type 1 and Type 2 Diabetes During the First Three Waves in Sweden

Abstract

OBJECTIVE Type 2 diabetes is an established risk factor for hospitalization and death in COVID-19 infection, while findings with respect to type 1 diabetes have been diverging. RESEARCH DESIGN AND METHODS Using nationwide health registries, we identified all patients aged ≥18 years with type 1 and type 2 diabetes in Sweden. Odds ratios (ORs) describe the general and age-specific risk of being hospitalized, need for intensive care, or dying, adjusted for age, socioeconomic factors, and coexisting conditions, compared with individuals without diabetes. Machine learning models were used to find predictors of outcomes among individuals with diabetes positive for COVID-19. RESULTS Until 30 June 2021, we identified 365 (0.71%) and 11,684 (2.31%) hospitalizations in 51,402 and 504,337 patients with type 1 and 2 diabetes, respectively, with 67 (0.13%) and 2,848 (0.56%) requiring intensive care unit (ICU) care and 68 (0.13%) and 4,020 (0.80%) dying (vs 7,824,181 individuals without diabetes [41,810 hospitalizations (0.53%), 8,753 (0.11%) needing ICU care, and 10,160 (0.13%) deaths). Although those with type 1 diabetes had moderately raised odds of being hospitalized (multiple-adjusted OR 1.38 [95% CI 1.24–1.53]), there was no independent effect on ICU care or death (OR of 1.21 [95% CI 0.94–1.52] and 1.13 [95% CI 0.88–1.48], respectively). Age and socioeconomic factors were the dominating features for predicting hospitalization and death in both types of diabetes. CONCLUSIONS Type 2 diabetes was associated with increased odds for all outcomes, whereas patients with type 1 diabetes had moderately increased odds of hospitalization but not ICU care and death.

Comparative Analysis of COVID-19 Outcomes in Type 1 and Type 2 Diabetes: A Three-Year Retrospective Study

“…In a study covering the initial three waves of the COVID-19 pandemic, researchers observed a significantly higher likelihood of severe COVID-19 outcomes, including hospi-talization, intensive care unit admission, and mortality, in individuals with type 2 diabetes, which corroborates our findings that compared three consecutive years of the pandemic [28]. Notably, younger individuals with type 2 diabetes exhibited disproportionately higher odds for these severe outcomes compared to their older counterparts and the general non-diabetic population.…”

“…Thus, our study contributes to the limited information on how COVID-19 affects T1D patients. The prevalence of T1D in our COVID-19 cohort was 31% compared to global reports ranging from 0.15% to 28.98%, illustrating the diverse clinical presentations and outcomes in this patient population [28].…”

Long‐term effects of coronavirus disease 2019 on diabetes complications and mortality in people with diabetes: Two cohorts in the UK and Hong Kong

“…Thirdly, because the exposed group was distinguished from the unexposed group based on the latter not having a positive COVID‐19 PCR test result and not being hospitalized with a COVID‐19–related diagnosis admission code, there remains the possibility of asymptomatic COVID‐19–infected participants, who could not be diagnosed, being included in the control groups. Moreover, while existing studies suggest a difference in risks of COVID‐19 between patients with type 1 diabetes and type 2 diabetes, 45 because of the limited number of patients with a diagnosis of type 1 diabetes in the dataset, the statistical power was insufficient to analyse the risks in patients stratified by type of diabetes. Lastly, because of the limited sample size of COVID‐19 patients with diabetes, especially those with severe disease, associated risks identified for certain disease complications may be affected by low event rates and high CIs.…”

Predictive value of hematocrit, serum albumin level difference, and fibrinogen-to-albumin ratio for COVID-19-associated acute respiratory failure

“…Additionally, patients with diabetes and COVID-19 experience excessive activation of the coagulation system, microthrombus formation, and stagnation of pulmonary circulation, which result in decreased oxygenation. Jon et al proposed that patients with type 2 diabetes are at high risk of severe COVID-19 and therefore increase the ICU occupancy rate [ 34 ]. Patients with type 2 diabetes exhibit high levels of ACE2 receptors, which may extend the cell-binding period of SARS-CoV-2 and increase the viral load and infection severity [ 35 ].…”