Type 2 Diabetes and COVID-19–Related Mortality in the Critical Care Setting: A National Cohort Study in England, March–July 2020

Abstract

To describe the relationship between type 2 diabetes and all-cause mortality among adults with coronavirus disease 2019 (COVID-19) in the critical care setting. RESEARCH DESIGN AND METHODS This was a nationwide retrospective cohort study in people admitted to hospital in England with COVID-19 requiring admission to a high dependency unit (HDU) or intensive care unit (ICU) between 1 March 2020 and 27 July 2020. Cox proportional hazards models were used to estimate 30-day in-hospital all-cause mortality associated with type 2 diabetes, with adjustment for age, sex, ethnicity, obesity, and other major comorbidities (chronic respiratory disease, asthma, chronic heart disease, hypertension, immunosuppression, chronic neurological disease, chronic renal disease, and chronic liver disease). RESULTS A total of 19,256 COVID-19-related HDU and ICU admissions were included in the primary analysis, including 13,809 HDU (mean age 70 years) and 5,447 ICU (mean age 58 years) admissions. Of those admitted, 3,524 (18.3%) had type 2 diabetes and 5,077 (26.4%) died during the study period. Patients with type 2 diabetes were at increased risk of death (adjusted hazard ratio [aHR] 1.23 [95% CI 1.14, 1.32]), and this result was consistent in HDU and ICU subsets. The relative mortality risk associated with type 2 diabetes decreased with higher age (age 18-49 years aHR 1.50 [95% CI 1.05, 2.15], age 50-64 years 1.29 [1.10, 1.51], and age ‡65 years 1.18 [1.09, 1.29], P value for age-type 2 diabetes interaction 5 0.002). CONCLUSIONS Type 2 diabetes may be an independent prognostic factor for survival in people with severe COVID-19 requiring critical care treatment, and in this setting the risk increase associated with type 2 diabetes is greatest in younger people. In early 2020, coronavirus disease 2019 (COVID-19), caused by the new highly infectious organism now known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was formally declared a public health emergency of international concern by the World Health Organization (1). With a global prevalence of 9.3% (2), it is unsurprising that diabetes is one of the most common comorbidities seen in people

Type 2 Diabetes Mellitus and COVID-19: A Narrative Review

“…In Italy, a diabetes prevalence of 17% was reported in patients admitted to intensive care units for severe COVID-19 (16). Recent data confirmed the findings mentioned above, outlining a diabetes prevalence of 18.3% in English people with severe COVID-19 requiring critical care treatment (high dependency unit or intensive care unit) (21). Other study showed a significant prevalence of diabetes (30.05% vs 19.57%) in dead patients compared to survivors in ICU wards in Spain (22).…”

Diabetes predicts severity of COVID‐19 infection in a retrospective cohort: A mediatory role of the inflammatory biomarker C‐reactive protein

“…However, these findings could still be relevant to clinically well COVID-19 patients monitored in the community or primary care setting. Third, patients with Types 1 and 2 DM were not differentiated in our study, as both types of diabetes were reported to have an increased risk of adverse COVID-19 outcome, 46,47 and separating them would have further reduced the statistical power of our analysis. Fourth, testing of IL-6 or tumor necrosis factor-α as inflammatory markers were not available for routine use in Singapore as they are not cost-effective compared to CRP.…”

Diabetes and COVID-19: The past, the present, and the future

“…Meanwhile, a nationwide retrospective cohort study from the UK evaluating COVID-19 Hospitalisation in England Surveillance System (CHESS) found that COVID-19 patients with T2DM hospitalized in the critical setting (high dependency unit (HDU) and ICU were at 23% increased risk all-cause mortality; adjusted hazard ratio (aHR) of 1.23 [95% CI 1.14, 1.32]), which was lower than the aforementioned studies [24]. Importantly, the aHR for the younger age group (age 18-49 years) were significantly higher compared to the older groups ( [25].…”